In our society, alcoholic beverages are very common, and since people living with bipolar disorder are just like everyone else, they absorb the same messaging surrounding drinking. From the simple wedding toast to “wine o’clock” and “beer thirty” to celebrate the end of a long work day, imbibing a drink is as common as breathing. But is this the best choice for people managing bipolar disorder?
It is a complicated question that depends on a myriad of factors like where you are in your recovery or whether you take medication to treat bipolar. In this episode, we discuss just how big of a deal mixing alcohol and bipolar disorder is, answering questions like “Is it really dangerous?” and “Do you need to quit drinking entirely or can you just have a little bit?”
We also delve into whether it is possible to regulate bipolar disorder with alcohol. Join us as Gabe and Dr. Nicole discuss the ins and outs of alcohol use and staying stable with bipolar disorder.
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Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.
He is also the host of Healthline Media’s Inside Mental Health podcast available on your favorite podcast player. To learn more about Gabe, or book him for your next event, please visit his website, gabehoward.com.
Dr. Nicole Washington is a native of Baton Rouge, Louisiana, where she attended Southern University and A&M College. After receiving her BS degree, she moved to Tulsa, Oklahoma to enroll in the Oklahoma State University College of Osteopathic Medicine. She completed a residency in psychiatry at the University of Oklahoma in Tulsa. Since completing her residency training, Washington has spent most of her career caring for and being an advocate for those who are not typically consumers of mental health services, namely underserved communities, those with severe mental health conditions, and high performing professionals. Through her private practice, podcast, speaking, and writing, she seeks to provide education to decrease the stigma associated with psychiatric conditions.
Find out more at DrNicolePsych.com.
Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.
Announcer: You’re listening to Inside Bipolar, a Healthline Media Podcast, where we tackle bipolar disorder using real-world examples and the latest research.
Gabe: Welcome to the podcast, everyone. My name is Gabe Howard and I live with bipolar disorder.
Dr. Nicole: And I’m Dr. Nicole Washington, a board-certified psychiatrist.
Gabe: Dr. Nicole, there are two things that get me angry emails. One, whenever I criticize mania. Two, whenever I mention that people with bipolar disorder shouldn’t drink alcohol. Those are the two biggest triggers in the community that make people just beside themselves angry. And. And they, they have opinions.
Dr. Nicole: Yeah, because it’s legal. It’s legal. And you just don’t want people to have fun. Good legal fun. So, what’s the big deal?
Gabe: That’s what I get. They’re how can you judge me? How can you speak in absolutes? You said that black and white thinking was bad. I can drink if I want to. Nothing bad has ever happened when I drink. Who the hell do you think you are? That’s my personal favorite. Who the hell do you think you are? And over the years I’ve really desperately tried. I was like, you know, it’s probably not a good idea. Your mileage may vary, in general. No matter how I say it. Here’s what people hear, Gabe said, I’m not allowed to do something and I’m allowed to do and he’s an ass. I just so. So, I give up. Listen, if you live with bipolar disorder, drinking in general is not a good idea for you. Please, please don’t, don’t, don’t hit stop. Don’t hit stop. Hear us out. We have reasons. We’re going to give them to you so that you can make an informed decision. Do not. They’ve already. They. I guarantee we’re going to look through the stats, half the people have stopped listening. Just trust me on this one.
Dr. Nicole: I think they’re going to keep listening just so that they have more fuel to send you more you’re an idiot emails. I don’t think they’re going to stop. I think you’ve piqued their interest and now they want to hear what you have to say.
Gabe: I hope that’s the case. And for what it’s worth, you’re right. The blanket statement that every single person with a bipolar diagnosis cannot drink is wrong. It’s not a good idea, the majority. But your mileage may vary and you may well be able to handle it. But even if you are somebody who can handle it, at least be aware of the potential pitfalls so that you can protect yourself. Now, Dr. Nicole, you are a doctor. Right. I want to I want to borrow your medical degree. Just forget about bipolar disorder for a second. Alcohol impacts the brain. Alcohol makes people different. How does that work? Not in people with bipolar disorder, just in general. Why do people like alcohol so much?
Dr. Nicole: People think it’s fun. I mean, people think, oh, if I drink, I’ll be more relaxed. I’ll be able to have fun. I’ll be the life of the party. It’ll relax me. All of those things are true. It will relax you. You have a balance in your brain between these inhibitory neurotransmitters and these excitatory neurotransmitters, and you have a pretty good balance most of the time, unless there is something going on there that that alters the balance and alcohol tips things a little bit and you feel relaxed and you feel lighter and it hits the GABA. We’ve all heard about GABA, it hits those GABA receptors and you’re like, this feels amazing. The only problem is there’s the other side of that. It can also cause you to have trouble with your balance or your short-term memory or some people, that lack of inhibitions may lead to them being not so nice. And maybe the things that they’ve been holding back are things that they should hold back. So then that that wall is down. The fence is down and your thoughts are just able to run free. So, when they make comments about people being their true selves when they’re intoxicated, there may be some truth to that. So, some of the things that they’ve been inhibiting and holding back just really pop on out when you when you’re intoxicated. So, you may notice that those are the things that you like about it, but they can also be the things we don’t like about it.
Gabe: And just to remind the audience, we’re still staying on alcohol on the non-bipolar brain. People drink it because it makes them feel good. They have liquid courage. I’ve heard all of these things and you alluded to the angry drunk and people feel like they have more fun or that they feel lighter or that it helps them forget or move forward.
Dr. Nicole: Yeah.
Gabe: And I’m not making any judgment on whether or not that’s a good idea. But it’s well accepted and understood in our society that people drink because it impacts their mood. Now, we can argue until we’re blue in the face, whether it impacts your mood in a good way or a bad way. But we all at this point should agree alcohol impacts mood. Now let’s talk about bipolar disorder. Bipolar disorder impacts mood, and then you’ve dumped another thing on top of it that impacts your mood. So, it’s just it’s like pouring gasoline on a fire.
Dr. Nicole: Absolutely. So, we have to start from square one. So, we go back to talking about bipolar disorder, making sure that person has a good understanding of how it can affect their mood and what that looks like. And then I talk about how alcohol can affect mood, whether you have bipolar disorder or not. And then we talk about how combining the two can be problematic for some folks.
Gabe: One of the things that I always hear is that people say, look, look, I’m regulating with alcohol and I want to be fair. Like, I want to ask like, what do you mean you’re regulating? And they’re like, listen, alcohol is a depressant. And I have racing thoughts. I have racing thoughts. And when I drink, it slows down those racing thoughts. Now, it almost sounds reasonable, right? Because you’re racing thoughts, you know, zoom, zoom, zoom, zoom, zoom, zoom, zoom. Take a couple of drinks, etc. And then it’s zoom, zoom, zoom. All right. It it’s now suddenly more manageable. And so many people have said to me, look, if a pharmaceutical company invented alcohol that slowed down racing thoughts, we’d give them billions of dollars and call them heroes. How come when I do it, it’s bad? But again, it’s doing so much more than that. Maybe it’s slowing down your racing thoughts. That’s good. But the side effect is lowering inhibitions or making you sad. Remember that it’s a depressant that means depression. I hate to ask you how all of this is impacting the bipolar brain because it’s just not well understood. The brain is not well understood. Bipolar disorder isn’t well understood. And even things like alcoholism, we’re still struggling to determine if it’s a disease or a personality defect. So, it’s not a straightforward answer.
Dr. Nicole: In the long term. It’s not a good idea. So, where I struggle is people say, well, can I drink every now and then? Can I have one every now and then? My thought is I would prefer a person not drink at all. And the reason for that is because we know what happens if you are drinking to help you sleep better, for example. So, a lot of my people with bipolar disorder will say, well, I just like to drink at night to help me sleep because I really have a hard time sleeping. And honestly, I just hadn’t been able to find anything to really help. The doctors don’t really want to give me anything for sleep. I don’t want to take that Ambien stuff. Like I get all these, all these things. Alcohol will 100% help you fall asleep. Full stop. No disputing it will help you fall asleep. Alcohol will also mess up your sleep cycle so you won’t get great quality of sleep. And we have to remember alcohol is a controlled substance. So, remember we talked about how initially when you drink it tips you toward, you know, that that inhibitory side and all is well, but eventually your brain’s going to figure out how to balance it back out.
Dr. Nicole: And then you’re going to need more and more and more to get that same effect. More and more and more, your body’s going to get dependent on it in time. Your body can’t help it. It’s not it’s not you abusing it or you going all in or binging. Eventually you will not get the same effect that you get from routine drinking. So, what do you do? You add another glass, you add another cocktail, you add another few ounces, you add a few more beers, whatever that looks like. And then eventually we are in bad juju territory because then your body is waking up in the morning going, um, I need it. Hello. Where are you? And you’re having a drink in the morning and cut the shakes out or you’re having these mood swings or you’re having sweats and tremors and all these things. It’s just not worth it. Because ultimately what you did it for was to achieve a level of balance and to be able to sleep or to act or to feel normal in quotes. But in time, you’re going to feel the complete opposite of any of those things because your body can’t help but get adjusted to it and want more and more and more.
Gabe: In every single discussion of using prescription medications, the number one reason that people give for not wanting to take them is the side effects. It makes me feel bad. It makes me feel different. It causes sexual side effects or it makes me feel blah or inhibits my ability to think freely. And those are all very good reasons. They are all very, very good and valid concerns about taking prescription medications. But I’m always surprised when we get over into, oh, well, I fall right asleep after a couple of drinks of alcohol. Okay, so you’re, you’re drinking to fall asleep. So, do you wake up with a hangover? Oh, well, yeah, but I don’t care about. But that’s a side effect of the treatment that you’re picking. Also, if every single night you have to drink, where does this work itself out? What happens when you’re on a business trip and you can’t wake up with that hangover? What happens when you’re at the in-laws’ house or meeting the boyfriend’s parents for the first time and you don’t want to drink or you’re in a sober place or, you know, a sober household where they’re not offering this and then all of a sudden what happens? And what I’ve seen happen when people are utilizing alcohol as a sort of, you know, treatment method, what I see happen is people get real fidgety and real angry and real defensive and
Gabe: Clearly something is going on because they can’t get to the alcohol. I find that very alarming when you are so dependent upon alcohol, that’s when we start to get into, have you considered we might be into do you have an addiction on top of your bipolar disorder? And I can tell you from my work as a mental health advocate, managing serious and persistent mental illness all by itself, extraordinarily difficult. Managing a substance use or alcohol disorder all by itself, very difficult. Merging the two together, it becomes really impossible because you think you don’t know where you begin and bipolar ends or where bipolar begins and you end? Wait until you try to figure out what’s bipolar and what’s alcoholism. When folks come to you, Dr. Nicole and they don’t seem to be aware of these inherent risks, what advice do you give them to move them along? Because there’s this real big blind spot that, hey, I just have a couple of glasses of wine. They do it in Europe all the time. It’s fine.
Dr. Nicole: I agree with you completely. And sometimes it can be very frustrating for me, too, to sit across from someone who is making the argument that they would rather drink alcohol than to take medication. Right. As my children say, the math is not mathing. Two and two is not equaling four. You are telling me that your goal is to achieve stability, sleep well, to feel great, and to feel medicated without feeling medicated. Yet you want to treat your symptoms with alcohol that you’re bound to become physically dependent too, whether you plan to or not, that is going to interfere with your sleep cycle, that you may feel hungover from, that can damage your body. There are all these things and all these reasons why we can point not alcohol. But yet. Yet. And still, I still have people who will just argue with me and sometimes will yell and not be nice to me because this is the this is the hill they choose to die on. So, it can be extremely frustrating on my end. And really, that’s where I start. I start with this conversation of what’s the goal? And we go through a pros and cons. What’s the goal? What is the good side of you doing medication? What’s the downside of medication? What’s the upside of drinking? What’s the downside of drinking? And from there it’s in your court. I can’t make anybody do anything. I tell them I cannot follow you around 24/7 and knock, you know, alcohol out of your hand like Mutombo and shake my finger and say, uh uh uh, I can’t do any of that. Like, I can’t do that. Um, so then the decision is yours. I would like you to make a decision that I feel like is the healthiest decision for you and in your best interest. But I fully realize that my definition of what is in your best interest and what is actually in your best interest do not always align.
Gabe: Let’s stay on comorbidity for a moment, because I imagine that one of the hardest parts of your job is figuring out what’s driving what. For example, let’s say that I am a drinker. I am drinking, and you’re concerned that I’m drinking too much. It’s no longer moderate. It’s we’re definitely in I have a substance use disorder along with bipolar disorder. And I come to you, my trusted Dr. Nicole, and I say, look, I’m feeling depressed and I lack motivation. Now, bipolar disorder can cause depression and a loss of motivation. Alcoholism can cause depression and a loss of motivation. So now I’m looking at you, staring you straight in the eyes, and I’m like, All right, you’re the doctor. I’m ready to listen. Fix it. Where do you even begin to unravel that mess?
Dr. Nicole: I want to know how much are you drinking? How often are you drinking? How much control do you have over your drinking? If someone tells me, you know, I drink a few days a week. Do you do you ever drink a lot during those few days a week or that couple days a week? Are you drinking very little? Are you planning to drink very little, but it always tends to escalate to a lot? Those are the kinds of things I want to know. We have these screening questions in in the medical world called CAGE questions. And these are four questions that we ask people just to kind of screen for whether we should be concerned about their substance use. For someone who drinks, the question would be, one, the C, have you ever considered cutting down? So, have you ever thought maybe I shouldn’t drink so much? Maybe. Maybe I should back up a little bit? Maybe I shouldn’t go out as many nights a week, whatever that cut down looks like. Have you ever considered that? The A is annoyed. Have you ever been annoyed by other people telling you drinking too much? I don’t like when you drink. You need to cut down. If you’re annoyed by those statements from people who are closest to you and who love you, you may want to consider the impact that not only is your drinking having on you, but maybe the impact that it’s having on other people. The G is guilt. Like, have you, have you felt guilty? Have you, have you felt guilty about your drinking? And the E is eye opener. Have you had to take that drink in the morning to cut the shakes out so you could go to work? So, you could drive, so you could perform your job without having a visible tremor and nausea and vomiting and all those things?
Dr. Nicole: If any of those are yes, what’s going on with you and if it’s interfering. And sometimes people just get upset with the questioning. They don’t like being questioned about these kinds of things. And the reason I questioned is because what I know is that about 25% of people who have any of the severe mental illnesses, depression, schizophrenia, bipolar disorder, have a substance use disorder along with it. Nobody’s accusing you of, people get mad and they say, you’re accusing me of being a drunk. I would never use that word. I would never use that word for anybody. But I am checking in because I know how easy it would be to be pulled towards something that’s readily accessible that I don’t have to go see a doctor for that I don’t have all the conspiracy stuff that I have for Big Pharma, which you should, because alcohol companies are also shady and scammy. But neither here nor there. But I know how easy it would be to choose that because it’s the path of least resistance. It’s easy to access. You can get it just about anywhere. Heck, it may be a lot cheaper than medication options in some cases, depending on how discerning your alcohol preferences are. But nobody’s blaming you. Nobody’s pointing fingers. So, I have to get through all of that. Just to be able to come up with a plan on how do we address it?
Gabe: As someone who lives with bipolar disorder, I completely understand this idea that, hey, look, if I can go out with my buddies and have a couple of drinks, if I can get together with my girlfriends and have a couple of drinks if I can if I can sit and watch a game and throw back a beer, if I can get done at work and have a drink to reward myself or whatever this is. Listen, all of my friends who have kids have its wine 30 wooden plaques hung in their kitchens. Just alcohol is everywhere. And I only bring that up because that means it’s normal. It’s everywhere in our society. It’s normal in our society. If somebody sees you drinking a glass of wine, they don’t say boo. They in fact, they might ask for one themselves. Somebody sees you pull out that giant pill case from your purse, your satchel, your glove box, your pocket, and they’re like, what are you doing there? Especially for our younger listeners. I remember being 26 years old and carrying a pill case that was bigger than my grandparents’ pill case and how that felt. So yeah, there is a huge, huge part of me that is just like, hey, look, I don’t, I don’t, you know, I think there might be a market here. Could you imagine if we make an energy drink that has your bipolar cocktail in it? Right. And you just you just throw that back and it’s got like all your meds, like you go to your Dr. Nicole. It’s like, here are the six drugs that you need. We put it in a blender, right? And just and then we could call it like, like monster rockstar, right? And you just you drink one in the morning, one at night before bed. Like that would feel so normal. I don’t know why we can’t get there. But I do know that taking pills feels abnormal and drinking with your friends, it feels Americana. It feels like a slice of life. It feels people gather around you.
Dr. Nicole: Mhm. And I think these are two separate kind of things to tease out too. So, there is the side of I want to feel normal, I just want to be like everybody else. I want to be able to go to happy hour with my friends and not have to say sorry guys, I’m not drinking because I’m taking meds. And my psychiatrist said not to mix them with alcohol. But the reality is you don’t have to do that. You don’t have to make a grand announcement to people that that you’re not drinking. You can do the decoy drink. I mean, I’m not a big drinker, but when I go out socially, I am a huge fan of a club soda with a splash of grenadine. If people think I’m drinking and they don’t bother me, nobody’s like, let me. You don’t have a drink. Like, what are you doing? They just assume I’m drinking something fun and they leave me alone. Um, I have told bartenders like, hey, I’m not drinking. If this person comes and tries to buy me a drink, can you please just give me a sprite with a splash of grenadine? They’ll think it’s like a vodka soda or a vodka cranberry or something, and they’ll leave me the hell alone. You don’t have to make grand announcements like, oh, sorry, guys, I have to be mindful of my bipolar disorder so I will not be joining you all for cocktails this evening.
Dr. Nicole: I will be having a Sprite. Please don’t ask me to have a drink. You don’t have to do that. Right? And if you have a problem doing that, then that is something you need to work out with your therapist. Is there an addiction kind of thing where you can’t avoid it? Do you need to come to terms with your diagnosis and how to share that with the world or how not to share that with the world and still keep it moving? Those are all things that you can work on with your therapist to kind of help you tease those things out. But we don’t have to feel like we’re missing out because we’re not drinking, because there are lots of reasons why you may choose not to drink. Medical issues. You’re driving. You’re just trying to cut your carbs. There are a lot of reasons you just may not feel like it. And if you can’t have fun without drinking or you don’t feel like you can relax and be yourself again, I need you to hit up your therapist and talk through whatever was going on during that moment, because that really may not be so much a matter of, well, I need to because all my friends are, I want to feel normal. That’s something else. And we need to figure out what that something else is.
Gabe: When it comes to managing a bipolar diagnosis, I feel that one of the things that that sometimes happens is we just we can’t be alone. Right? Whether it’s hypomania, mania, whether it’s anxiety, whether it’s just this desire to slow down the racing thoughts through activity. We want to go out and be around other people. And for me personally, I can only see the world through the lens of my own eyes. I would stay up all night and it was very difficult to find places to go, to be around people, that didn’t have an alcohol component. You couldn’t go hang out at the library, that closed at 7 p.m. Or you couldn’t. Restaurants closed at ten. Fast food places closed at ten. So that left well, frankly, establishments that sell alcohol. So, you go there and then there’s this not only is there this expectation, but there’s also that desire to feel normal. Everyone else is drinking. I want to drink so that I can share in the revelry. So that I can be accepted, so that I can I can make my way into the dart game or watch the sporting event and be just like everybody else. And being just like everybody else is a big, big thing for people with bipolar disorder because we often feel like we aren’t connected.
Gabe: Now I want to let the audience know I did. I did not handle this well. I drank and drank and drank and abused drugs and alcohol. And I wanted to be like super transparent. Everything that I’m about to say are hard fought lessons that I learned after the fact. So, take my advice because I didn’t use it. One of the things that I realized is that I could have still gone to those places and I could have said, hey, I’m the designated driver or I have to work in the morning. And of course, as Dr. Nicole so eloquently said, people just don’t care about you. They’re not actually invested in what’s in your glass. If you bring your personality, your friend, your you like the same team that they do or, or you’re easy to beat at pool or really good at pool. I really do think if you want to get in good with the folks at these establishments you just need to have a good personality and be engaging. I really don’t think they care about the contents of your glass. They care about the contents of your character. I’m not trying to be sappy. That’s just, that’s just true. We all know people who drink a lot and we don’t want to be anywhere near them. The reverse is also true.
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Gabe: And we’re back discussing bipolar disorder and alcohol use.
Dr. Nicole: You have to ask yourself, why do I think that I have to do this one thing to be like everybody else? I’m sure there are tons of traits that you can have in common with people. Nobody cares when people are pushing you like, oh, let me get you a drink. It’s not because they just literally want you to ingest alcohol. They just want to make sure you’re taking care of. They want to make sure you’re having a good time. And sometimes they go a little overboard, but you don’t need an extra substance to get people to like you. If they’re not your people and they just don’t get you or they just aren’t going to be your kind of people whether you drink or not. They’re just not. And if you have to put up a false sense of who you are to get people to like you, we need new friends. And so, we are going to work on building communities and building the people who care about me enough to not care if I drink at all.
Gabe: As I started off at the beginning, I know that the angry emails come because it’s just it’s such a ubiquitous part of our society. It’s just everywhere. And I really do believe that, especially with depression and anxiety and all of the things that bipolar take to feel that one more thing is being taken away is a lot. Reframing is super important here. Nobody is taking your friends. Nobody is taking the football game. Nobody is taking wine 30 with the girls after work. All of these things can still be done because they’re about meeting the people. They’re about connections. They’re not actually about the drink in your glass. That said, I understand alcohol marketing is incredible. Everyone is always having so much fun. You know, I have never, ever seen an alcohol ad
Dr. Nicole: Right.
Gabe: With somebody who’s just like, my life sucks. I hate everything. I’m going to get drunk and pass out in my easy chair.
Dr. Nicole: Yeah.
Gabe: Everybody is surrounded by people and friends and having the best time of your life yet come on. Here’s some real talk. I am in those support groups and every single person who is ever brought up substance use disorder or alcoholism has not talked about it in a fun way. We have only talked about it as taking away from us, from hurting us. And yet the reason we want to do it is because we go back to one of those commercials we saw and we’re like, but I want that. That is false. It’s not true. You heard it here first, ladies and gentlemen.
Dr. Nicole: Yeah. You mean all advertising isn’t 100% accurate? I’m floored. I don’t. I don’t even know what to think of. Everything on the internet isn’t true either? Is that what you’re going to tell me next?
Gabe: I too am shocked. And sincerely, Dr. Nicole. The same group of people that are like, look, you can’t trust portrayals of bipolar disorder in the media or in pop culture because it’s not true is also the same group of people. And I know because I’m in that group who says, well, but you know, drinking is Americana. It’s a pastime. It’s a thing that you do with your friend. You’ve seen movies. Everybody likes it. Wait a minute. Did you just use the media as both a bullshit source and a real source in the same sentence? Yes, I did. If we if we really stop and think about it for a moment, what we’re trying to get is connection and stability. And more often than not, alcohol is standing in between us and what we desire. And we need to remember that.
Dr. Nicole: Yeah. And everything isn’t always black and white. And I think that is a is a very hard thing to grasp, especially when you’ve been diagnosed with a mental health disorder, a serious mental health disorder. Things feel pretty concrete at times. They feel like things are either all good or things are either all bad, you know, they’re either good or bad. So, things can be both, you know, it can be both. And, you know, alcohol is not the devil. I don’t think that it’s the horrible thing that that maybe we’re making it out to be. But I think that for certain people, it can be a horrible thing. And so, then those people, I think Well, I don’t think, I know. Have to put the work in to figure out, well, what else am I going to do? And if alcohol is that thing that gives you relaxation and you can hang out with friends and you can breathe a little easier. We just got to replace it with something. It’s not it’s not it’s not rocket science. It really, really isn’t. But sometimes our brains don’t take us there. A great example of that is remember when the pandemic started? All of my patients like just about every last one of my patients who used exercise and going to the gym as a coping mechanism, completely lost it at the beginning of the pandemic because gyms were closed. So, my people who are like, I go to the gym, I do CrossFit, I do like I go work out, I lift weights.
Dr. Nicole: I do. You know, those people were falling apart. They were they were falling off the bone, as I like to say. They were they were just out here trying to figure out what do I do? Like, I feel lost. I feel like I’ve lost something. They were almost in mourning. And also, every time I say it. But can we replace it with something like can you walk out? Can you replace your gym membership fee with weights at home? There was this light bulb thing that kind of went off like, oh, I hadn’t really thought about that. So, I think as a culture, we get very into our routines and our things and we don’t want to feel like something’s being taken away from us. Our choices are being taken away from us, just like those people. Their choices weren’t being taken away. It wasn’t the physical gym that was the recharger or the relaxation. It was the activities that happened at the gym. So how do we replace the physical place? How do we replace that same group of activities, set of activities that recharges you? How do we do that in a different environment that is more realistic now that they were in a pandemic? For you, how do I take those same feelings that I have when I when I drink? How do I take that same joy? How do I find a way to get that same level of relaxation without doing something that could be harmful to me down the road? And it’s not necessarily always an easy task, but it can be done.
Gabe: One of the things that we hear a lot of the people are like, well, I don’t drink that much. I only drink occasionally. And the first thing that that I want to say is if you only drink occasionally and it’s not hurting you, it may well be fine for you. I’m not I’m not living your life. I don’t know. But one of the questions that I always push back is, okay, you only drink occasionally. And they’re like, yes, I only drink occasionally. I’m like, okay, does anything particular trigger it? And if they say, well, like when I have a rough day at work, I drink, or when the kids are really getting on my nerves, I drink or and I’m just like, well, so wait a minute. You drink in reaction to something? And they’re like, Well, yes. And that something is almost exclusively negative or problematic in their lives. And that makes me wonder, Dr. Nicole, is this just a coping skill for them? And because it sounds like a maladaptive coping skill.
Dr. Nicole: So, some people will drink because they enjoy craft cocktails or mixology or whatever reason. And if like you said, if you’re a person who says, well, I have bipolar disorder and I take my meds and every now and then I like to have a craft beer and it has not affected you negatively and all is well. I am just going to always remind you of the potential harm it could do. But you know what? Do you. If, however, you are using alcohol to avoid some unpleasant, uncomfortable feeling, that’s when we have to start thinking about it being a maladaptive coping skill. We all have coping skills. Every last one of us finds a way to cope with stress. The question is, is it a healthy coping skill or is it what we call a maladaptive or an unhealthy coping skill? Are you eating to deal with it? Are you, are you drinking? Are you doing drugs? Shopping? Whatever it is that you’re doing to avoid these unpleasant feelings, it’s a coping skill. So, it’s either healthy or unhealthy. And the question becomes, is alcohol your unhealthy coping skill?
Gabe: The thing that I want to make sure the I only drink occasionally group really understands is, is that your motivation for that drinking is where it’s going to matter. And I sit in a lot of support groups. I talk to a lot of people, I read a lot of emails, and this comes up for a reason. You know, listen, if you’re like every year on my grandfather’s birthday, we take a shot in his honor of his favorite drink. And this doesn’t bother me at all. I do it once a year. Yeah, nobody’s trying to stop you, but that’s not what comes up. That’s. That’s not what the Dr. Nicoles are asking about. That’s not what the support groups are getting at. There’s, the things that we’re asking about, there’s this thread. There’s the there’s like these little breadcrumbs that lead someplace negative. You know, something happened. And when you start to do a chain analysis and you go backwards, it’s like, wait a minute, why were you drinking? Oh, because this happened. And of course, the chain analysis starts at I missed work. I yelled at my spouse. I was mean to my children. I missed a deadline or. Or worse. Right? Let’s leave the door open for worse. You’ve got to really look at we can’t do it for you. You’ve got to look internally and decide, why am I drinking? If you are drinking, to forget or resolve it could be a maladaptive coping skill. But the good news is, is maladaptive coping skills are well understood. And I don’t want to say that they’re easy to resolve, but it’s it you got good odds of doing it. Therapist and the Dr. Nicoles And even the support groups and the and the other people living with bipolar disorder, we have all faced it. We have all done it, and we can help you through it.
Dr. Nicole: May not be easy, but there are a million options out there and you can keep trying things until you find the right thing that helps you manage the unpleasant feelings, the sadness, the anger, the guilt, the whatever it is you’re trying to avoid in a better, healthier way.
Gabe: Dr. Nicole, when you’re pulling at these threads, what are people usually trying to cope with that they’re using alcohol to avoid?
Dr. Nicole: Any number of things, Gabe. Are you angry? Are you sad? Are you lonely? Do you feel guilty about something you did? Said? Are you trying to forget something that is unpleasant or traumatic from your past? Are you hoping to not deal with the symptoms that you have? And is this your way of coping with your symptoms? Some of this stuff is going to be just because you’re alive and human and we deal with unpleasant, crappy things all the time. Your need to have something to cope like this may just be because you’re alive and breathing and you just need better coping skills. But maybe you’re running from your bipolar symptoms, maybe you’re feeling a little hypomania or mania coming up and you’re running from it, and you’d rather just take a drink to kind of decrease it, squash it a little bit so you don’t have to think about taking medicine, whatever it is that is unpleasant for you you could be trying to deal with alcohol.
Gabe: I’m curious, do a lot of your patients talk to you about using alcohol with bipolar disorder? And is it, is it because of their concerns or because their loved ones have asked them to bring it up to you?
Dr. Nicole: If don’t ask, I probably will not get it, get an answer about it, or it may not even come up. I do find that most people don’t bring it up unless they’re asking me, well, can I have a drink because it’s my girlfriend’s birthday or it’s my anniversary and I’d like to have wine with dinner. So usually, people will bring that aspect of alcohol up. If I don’t ask, though, usually people will not bring it up unless they bring a loved one to the appointment or the loved one calls ahead of time and says, hey, they’ve been drinking. But a lot of times people will hide it because, I mean, if you’re drinking to cope with life and you’re drinking is getting a little out of hand. Most people are not just telling people, hey, I think I’m drinking too much, I need to cut back. It takes a little bit of time for people to usually get to that point. So usually, especially in the early phases, people will not bring it up if I don’t ask, which is why it’s important for your doctors to be bringing these questions up and checking in with you on this stuff.
Gabe: So, it really seems like a lot of people either don’t realize they have a problem with alcohol or they’re actively hiding that they may have a problem with alcohol.
Dr. Nicole: Absolutely. People just are either in denial or are they just don’t see it because we know that sometimes it’s hard to see our flaws within ourselves and other people are much more likely to pick up on those things than we are.
Gabe: So just to kind of drill this down, if the patient doesn’t disclose, you probably won’t know.
Dr. Nicole: So, no, you may not know. I mean, you may not be able to just look at somebody and tell like, oh, this person is bingeing or they drink a lot, especially if you just see them once a month or once every three months or once every six months. You just may not pick up on it. But, there may be other things that people tell me that lead me to question. So, if they tell me things like I lost my job and I start asking, why did you lose your job? I’m like, oh, I kept calling in or I was late a lot. Why were you late? A lot. Well, I’ve been drinking, hanging out with friends. And so maybe a couple times I was hung over. So sometimes people give me give me tidbits about their history that I can sometimes fish backwards and get that information. But just on physical appearance, until we get to a place where alcohol is causing you significant physical issues, you may not be able to see it on the surface.
Gabe: I want to be very clear. Just because you can hide it doesn’t mean that you should. If you’re not giving your provider all of the information, you’re not getting the best care. And it’s also important to point out and please correct me if I’m wrong, Dr. Nicole, let’s say that you’re taking your medication as prescribed and you are drinking and you’re not seeing any side effects. Right? Just you believe that you’re not seeing any side effects. You should still disclose to your provider that you are drinking on these medications because it could change how these medicines are interacting in your body. And it’s just a good idea for your provider to be aware of that, even if, again, you’re not seeing any adverse reactions.
Dr. Nicole: Yeah. No, I mean, you not sharing that information really isn’t helpful to anybody. You’re an adult if you’re making these decisions, we need to know.
Gabe: All right, Dr. Nicole, we’ve covered the reasons that people want to drink. We covered the challenges and not drinking. We’ve covered how it affects the bipolar brain. We’ve even covered how alcohol impacts people without bipolar disorder and the mythical way it is just transcended society to mean good times and joy. But there’s a great, great, great big elephant in the room, people who are taking prescription medications. It’s right there on the bottle do not take with alcohol. Why on earth can bipolar medications and alcohol not get along? What are the challenges in both drinking and taking prescription medications at the same time?
Dr. Nicole: Uh, here. Here we go. Well, one, there are several medications for bipolar disorder that can cause sedation. So, you have one medication with a potential to cause sedation and then you’re going to add to it another substance that can cause sedation. So, then we have this double sedation possibility. We don’t have time for that, right? We just don’t. We need you to be alert. Your brain knows, oh, I should breathe because it’s just what we do. You’ve never a day in your life thought, oh, I forgot to breathe. Oh, I need to remind myself. You don’t set alarms to remind yourself to breathe. You just do it right. When we have too many sedating things on board that drive that your brain has that says, oh, we need to breathe regularly, often appropriately, it can go away. And we want our brains to remember to breathe. Because guess what? If it was our job, we’d die. We need that to happen. So, we don’t want to add sedating things on top of sedating things. Also, most of the medications that we prescribe are metabolized through your liver, and we know that alcohol directly affects your liver. We don’t need to put our liver through extra work or more work than we need to. It’s not it’s not a thing. It’s just not what you want to do. And in some instances, we are literally working against the medication by drinking alcohol because the alcohol is doing the exact opposite of what we are trying to accomplish.
Dr. Nicole: So, it’s not always necessarily that your alcohol intake, like alcohol, directly interacts with the medication as much as they can have. They can have similar effects as in a sedation. They can both hit your liver harder than we’d like to hit your liver. And if you take a lot of medications, that’s important. And then just behaviorally, I mean, I don’t like people who have mood disorders in general drinking. And I tell this to my people who have bipolar disorder, who have major depressive disorder, who have schizophrenia. I just I would love for you to be able to achieve a level of stability that is not dependent on you taking a drink or going to a bar or using an illegal drug or anything like that. Once you’re stable, then we can have that conversation that I ultimately hate to have, which is, but can I have one every now and then? Like it’s my birthday, I’m turning 21. Like, can I have one drink? That’s a whole different story. But let’s achieve stability before we ever even have that conversation.
Gabe: Dr. Nicole, before we get out of here, I just want to ask you one simple question. Are you being paid by the anti-alcohol industry to take alcohol away from people living with bipolar disorder? Do you get some sort of sick pleasure from telling people with bipolar disorder that that that drinking is not the best way for them to move forward and reach the recovery that they’re looking for?
Dr. Nicole: Listen, I’m not getting paid by anybody to say anything, because if I were, I’d have a pool right now, y’all. And I don’t. I don’t have one. So that is that I would have lots of things available to me that I don’t have. No, I am. I am. I am on the side of science, which is not always a popular side to be on here recently, but I and most likely your psychiatrist, your Dr. Nicole, your therapist. We are basing these things off of evidence and what we know to be true. We are not trying to take your fun away. What we are saying is that you are more fun probably than you know, and you can be more fun than you could ever imagine without those things on board. And that’s why we come at you the way we come at you.
Gabe: All right, everyone. My name is Gabe Howard and I’m an award-winning public speaker who could be available for your next event. I also wrote a book. It’s called “Mental Illness Is an Asshole and Other Observations.” You can buy it on Amazon, but you don’t want to because you want to get a signed copy with free swag just by heading over to my website, gabehoward.com.
Dr. Nicole: And I’m Dr. Nicole Washington. You can find me @DrNicolePsych on all social media platforms. On my website, DrNicolePsych.com.
Gabe: I need you to do a couple of things for us. First, follow or subscribe to the show. It is absolutely free and you don’t want to miss a thing. The second thing we need you to do is recommend the show, share it in a support group, share it on social media, share it on a Facebook group. I don’t we don’t care where you share it. Just share the show because it’s how we grow. We will see everybody next time on Inside Bipolar.
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