I was saddened to read of Demi Lovato’s suspected drug overdose this week. Whether or not her relapse was related to her bipolar diagnosis is impossible to know. We do know that mental ill health and substance misuse are a bad combination. The statistics are frightening: in the UK, 75% of individuals in drug services and 85% in alcohol services have a co-existing mental health condition. More on this here.
A significant issue in considering mental ill health and substance misuse is the chicken and egg nature of the problem. Did the substance misuse start first or was the mental ill health the cause of the substance misuse? Long waits to access specialist mental health services mean that self medication with substances can provide an outlet from troublesome symptoms. The chaotic lives of some substance misusers make engagement and ongoing treatment problematic. If you’re homeless, how do you receive appointment letters? If you aren’t earning, how do you afford the bus fare to get to appointments? When the day is structured around relieving immediate discomfort, are you going to regulate your sleeping and eating patterns and remember your meds? The answer is a resounding no.
I don’t do illicit substances (if my boss is reading this I’m sure she’ll be relieved) but I do drink. When I’m having an episode I tend to drink more. I’m sure that the motivations of each individual to misuse substances are different but here are my personal reasons behind using alcohol to cope with bipolar:
When I’m hypomanic, I love a party. I’m outgoing, chatty and definitely up for doing shots of tequila (yuck) at 3am. Hypomania gives me a super human tolerance to alcohol. It’s easy to get caught up in the fun especially if you’re with the wrong crowd as Lovato was reported to be. What’s fun and exciting at first ends up in a slow car crash when you inevitably fall off the hypomanic cliff.
When I’m depressed (and I’ve been depressed waaaay more than hypomanic), sleep tends to go out the window. I sleep 4-5 hours a night, waking at 2am and then wanting to drift off around 5:30am when I need to get up. I’m anxious and sad. Drinking helps me to relax, sleep and socialise when I’d rather hide in my room with the lights off. I don’t binge drink when I’m low but get into the habit of having one drink several nights a week, more on weekends. I completely get how 1 or 2 can turn into 2, 3 or 4.
Alcohol doesn’t help, not really. It’s a depressant, it stops your medication from working (in some cases its downright dangerous to mix your meds with alcohol). If you’re using other substances to self medicate then you’re adding to the adverse effect.
Situations like Lovato’s illustrate the need for a watertight crisis plan. This needs to be done when you are well. Who is looking out for you? What will they do if you hit a crisis? What do you want to happen when you’re unwell? Mine has various sections- a note of my early triggers (not sleeping, not eating), giving authorisation for my husband to discuss my care with my doctors if I’m acutely unwell, what I would be happy to undertake treatment-wise (would I agree to hospital admission- yes, would I ever have ECT, no). The plan needs to be shared and agreed by everyone involved. Not only does the plan help those around you in a crisis, it gives you a sense of security. I know if the sh*t hits the fan I’ve got a strong team who will step in even if it might not be what I want at the time. That support is worth its’ weight in gold.
Get well soon Demi Lovato, we’re all human, we all relapse, it’s what we do in the aftermath that counts. She needs support, she needs a crisis plan and above all she needs no judgement.
If you are struggling with substance misuse, it’s important to see your health professional. You can also find more information here.