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. 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
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.

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.

Acamprosate

Generic name: calcium acetylhomotaurinate

Use: Prevention of alcohol abuse.

Action, if known: Acamprosate is a calcium channel
blocker. It seems to stimulate inhibitory GABA receptors and to antagonize
excitatory amino acids, such as glutamate. This should prevent some of the
pleasurable, reinforcing effects of alcohol use.

Side effects: Diarrhea

Tips: Acamprosate is available in Australia and several
European countries, but is still in clinical trials in the US.

Antabuse

Generic name: disulfiram

Use: Prevention of alcohol abuse.

Action, if known: Antabuse works by inhibiting the enzyme
acetaldehyde dehydrogenase, which normally breaks down the toxic by-product
acetaldehyde that forms when the body metabolizes alcohol. If you drink
alcohol while taking Antabuse, acetaldehyde builds up immediately and you
will become violently ill.

Side effects: Drowsiness, mood swings, unusual sensations
in the hands or feet (tingling or pain). Antabuse can cause or exacerbate
heart or liver problems. Drinking large quantities of alcohol while taking
Antabuse can actually kill you.

Tips: Antabuse should be used only as part of a complete
recovery program, including counseling and peer support. People taking
Antabuse should be monitored for heart and liver problems. They must also
be careful to avoid healthcare and skin products that contain alcohol,
including many cough syrups. In addition, they should avoid contact with
the fumes of chemicals that may contain alcohol, acetaldehyde, paraldehyde,
or other related substances, including paint, paint thinner, varnish, and
shellac. Most doctors feel that Antabuse is of little or no help in
treating alcohol addiction–it is sometime used as a punitive,
court-ordered deterrence measure rather than a legitimate medical
treatment.

Calan

Generic name: verapamil

Also known as: Isoptin

Use: Angina, heart arrhythmia, high blood pressure,
prevention of alcohol abuse.

Action, if known: Calcium ion influx inhibitor.

Side effects: Dizziness, constipation, nausea. Lowers
blood pressure, can cause edema (water retention in the ankles and
legs).

Known interaction hazards: Do not use with beta blockers.
Calan may lower your lithium level. Potentiates digoxin. Be careful with
Calan if you use any other medication that affects blood pressure. May
counteract or interact negatively with verapamil, Quinidine, Disopyramide,
flecainide, neuromuscular blocking agents, carbamazepine, cyclosporine,
theophylline. Counteracted at least somewhat by rifampin, phenobarbital,
and Sulfinpyrazone. May interact with inhaled agents used in
anesthesia.

Tips: Blood pressure and liver function should be
monitored while taking this drug, especially in patients with known liver
damage. Take Calan with food.

Narcan

Generic name: naloxone hydrochloride

Use: Treatment of opiate and narcotic overdose or
addiction, reversal of the effects of anesthetics.

Action, if known: Opiate antagonist. Unlike ReVex and
ReVia, Narcan counteracts all of the effects of morphine.

Side effects: May raise blood pressure, may lower the
seizure threshold.

Known interaction hazards: Do not use with bisulfate or
alkaline solutions.

Tips: Naloxone has not been well-tested in treating
chemical dependency.

ReVex

Generic name: nalmefene hydrochloride

Use: Treatment of opiate and narcotic addiction or
overdose, reversal of the effects of anesthetics.

Action, if known: Opiate antagonist. Appears to activate
the hypothalamic-pituitary-adrenal (HPA) axis more strongly than
naloxone.

Side effects: Anxiety, nervousness, insomnia, abdominal
discomfort, nausea, headache, muscle or joint pain. May lower the seizure
threshold.

Known interaction hazards: Alcohol and all central nervous
system depressants, including anesthetics, narcotics, and sedatives. ReVia
may block the effects of these substances until they reach a critical, even
deadly, level.

Tips: Other than the difference already noted, ReVex is
essentially the same as ReVia–see the next entry.

ReVia

Generic name: naltrexone hydrochloride

Also known as: Trexan, NTX.

Use: Heroin/opiate and alcohol addiction withdrawal aid,
treatment of narcotic overdose, self-injurious behavior (SIB), reversal of
the effects of anesthetics.

Action, if known: Opiate antagonist–blocks opiate
chemicals.

Side effects: Anxiety, nervousness, insomnia, abdominal
discomfort, nausea, headache, muscle or joint pain. May lower the seizure
threshold.

Known interaction hazards: Alcohol and all central nervous
system depressants, including anesthetics, narcotics, and sedatives. ReVia
may block the effects of these substances until they reach a critical, even
deadly, level.

Tips: According to product literature, ReVia should not be
used by people who are currently addicted to drugs or alcohol–it is used
only after the detox process is over, to help the person stay sober.
However, a number of intensive detox centers do rely on ReVia, and it does
appear to help reduce cravings for drugs and alcohol. People with liver
problems must be closely monitored while taking ReVia. Recent studies
indicate that ReVia (and possibly other opiate blockers) can help stop the
cycle of self-injurious behavior.