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The statistics I see casually thrown about say that 50% of people with bipolar disorder have drug and alcohol problems. Bipolar disorder has the highest rate of substance abuse out of all of the Axis I disorders. Rates of alcoholism are seven times higher than in the general population. Not surprising, really, since the symptoms of this particular doozy of a mental illness are harsh enough to drive anyone to substance use and/or abuse. The common wisdom is that it’s primarily self-medicating to deal with intolerable symptoms, although illness-related impulsivity and impaired judgment probably play a role as well.

Self-medication? Oh yes, indeed. I started drinking in college because that’s what college students do, right? Of course. As mood swings started getting out of hand, I drank more. A lot more. Somewhere around the end of my sophomore year, however, I was beckoned into a dark room and initiated into the order of the potheads. I stopped drinking almost entirely. Cannabis was all I needed. So I stayed high most of the time when I wasn’t in class or working. The mood swings backed off. I graduated, moved in with my husband, and gave up alcohol entirely. High as a kite whenever I wasn’t at work, the crazy disappeared almost completely. For years.

Things smoothed out so much that I quit smoking cigarettes and lost 90 pounds at the same time. Then I started graduate school. Fast forward a few years: regular social drinking, and then drinking every day. Just a glass of red wine, like the French. Well, not exactly. The anxiety was getting tough to bear, but with a few tokes I could handle life, relax, and sleep easily.

Slippery slope: just one glass with dinner?

I started constantly traveling across time zones and drinking heavily during social events, all at the same time, which made me completely unstable. I didn’t smoke when I traveled, which probably contributed to getting so out of whack. The pot would calm me down, moderate my penchant for drink, and put me to sleep: exactly what I somehow couldn’t do when I was away from home. Before long, though, I was smoking and drinking every night. Up to a bottle of wine an evening, at times. Mr. Chickadee made caustic remarks that kept me in check, for the most part, but I could tell that it was getting to be a real problem. The alcohol issues peaked when I was out of the country for a month with no access to cannabis, lonely beyond words, and having massive unchecked mood swings. The antidepressant-only regimen kept me reliant on alcohol and pot.

My most recent former psych put me on mood stabilizers immediately and warned me to drastically reduce alcohol to avoid interactions. By then I’d already cut it way, way back, so no big deal. The next thing they did, however, was issue an ultimatum: they would only give me stimulants if I quit smoking cannabis. I really, really needed the ADD meds, so I complied despite being disgusted by the way they handled it.

With the mood stabilizers, I no longer felt any need to self-medicate. That is awesome. But I’m still bitter about being coerced into teetotalling rather than making the decision to clean up my act because I was ready for it. Cannabis saw me through 15 years of misdiagnosis. It cut off both the highs and the lows, acting like a mood stabilizer with minimal side effects – a total cakewalk compared to pharmaceuticals.

But untreated bipolar disorder just tends to get worse, and eventually it wasn’t enough. I was smoking pot just to get through my work day, and I was relieved that the mood stabilizers ended that. However, since the docs (in all their infinite wisdom) haven’t seen fit to give me effective anxiolytics, I’m still constantly fighting the urge to use cannabis as the only available means of relief when anxiety becomes overwhelming. I still very much want to self-medicate for those symptoms, but not every day.

I’ve been clean for 3 months now. Oddly, since quitting pot, I’ve had a constant overwhelming desire to start smoking cigarettes again for the first time since I quit in 2003. The craving is becoming overwhelming, particularly without adequate ADD meds. I’m sure it has to do with (permanent) dopamine imbalances. If it came down to it, I’d rather light up the green stuff than cancer sticks. I hate the lingering smell and harsh physical effects of smoking cigarettes, and smoking pot is pretty benign by comparison. But the longer I abstain from cannabis, the more inevitable the cigarettes seem. I think about it every day now, and that’s growing continually worse. I guess there’s no perfect solution for quieting my brain-crazies.