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

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

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. The cost of such treatment ranges to
well over $7,000.

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

The tricyclic antidepressants, SSRIs, and BuSpar have shown some promise in
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.

The following are medications that may be used to treat or prevent
substance abuse. It should be noted that their use is rare in treating
teenage patients.