When a young person has a dual diagnosis of chemical dependency and a bipolar disorder, most doctors choose to treat both conditions at once. This can be difficult unless the patient is in a hospital or other residential situation, where presumably he will not have access to drugs or alcohol. Doctors must also be careful about possible conflicts between medications for bipolar symptoms and medications used for other purposes.
Drug and alcohol withdrawal can be a painful process. Several neural and hormonal systems are affected by substance abuse, and when it ends they are thrown into confusion. Effects can include noradrenergic hyperactivity, gamma-aminobutyric acid (GABA)-benzodiazepine receptor alteration, elevated hypothalamic-pituitary-adrenal axis, and changes in the N-methyl-D-aspartate (NMDA) glutamate receptors. The patient’s blood pressure may soar or become unstable, she may sweat profusely or develop tremors. Severe nausea and physical pain is also commonplace.
For years, inpatient detox programs have prescribed the benzodiazepine tranquilizers as a way to blunt these difficulties. Unfortunately, these medications are also addictive — and may encourage patients to simply trade one addiction for another. They are still widely used to treat withdrawal from methamphetamine and cocaine, however, simply because there are few other medical options.
Methadone treatment is another option for heroin addicts. It involves swapping an illegal addiction for a legal one, which is controversial. However, methadone treatment has been shown to help keep drug addicts away from criminal behavior, and to help them become more productive members of society. When combined with counseling and other strategies, it may be a good first step on the road to actual detox. It certainly can improve the patient’s health in many ways, as methadone is administered in a clinic, comes in a reliable dose to eliminate the risk of overdose, and is drunk rather than injected. It is the treatment of choice for pregnant addicts.
Cold turkey detox is always an option — and for some people, it works best despite the temporary discomfort. However, today’s addiction specialists do have pharmacological tools at their disposal that can ease the pain and suffering of addicts in detox, and help prevent relapses. Intensive rehabilitation centers for people addicted to heroin and other opiates can use a one-day detox method that involves completely sedating the patient and administering ReVia or another opiate blocker intravenously. Follow-up care consists of continued use of oral opiate blockers and counseling. Some programs are also experimenting with implanted ReVia. Few teenagers can gain admission to these programs.
Some intensive detox programs claim a 75 to 80 percent success rate, although this cannot be confirmed through actual scientific research. The cost of such treatment can cost more than $1,000/day, and once your insurance runs out, the treatment facility will terminate your treatment and refer you to outpatient treatment for additional help.
Currently there are no cocaine or methamphetamine antagonists available for those who are addicted to these drugs (which are, unfortunately, the drugs of choice for many people with bipolar disorders, probably because of their paradoxically–and temporary–calming effects on some BP individuals). Several potential cocaine antagonists are currently under development, but so far there have been many roadblocks in this research. Cocaine works by preventing certain nerve cells from accumulating the neurotransmitter dopamine, making dopamine widely available to the brain and causing a euphoric high. Blocking dopamine entirely produces many ill effects on the body, however.
Heavy methamphetamine and cocaine abusers often experience the symptoms of psychosis. Neuroleptics are used to address these symptoms in some addiction treatment centers.
Supplementing with vitamin C, which can counteract the effects of prescription stimulants, may also help recovering methamphetamine addicts.
The tricyclic antidepressants, SSRIs, and BuSpar have shown some promise in helping recovering alcoholics stay sober. People with a bipolar disorder and substance dependency may find that recovery is easier if they use an antidepressant in addition to their regular mood stabilizer. Some doctors use clonidine or Tenex during drug or alcohol withdrawal.
For obvious reasons, young people with drug and alcohol addiction should not be given unfettered access to these or any other prescription medications. Doses should be given individually, and drugs should be securely stored. Counseling support, including 12-step programs, can be helpful in preventing the development of prescription drug abuse in recovering addicts.