There’s a lot of confusion out there. Most of it is nobody’s fault in particular. Education in psychology is pretty sparse, especially in pre-college public education. In fact, I never even had the opportunity to have a class on the subject until I got to college. In high school we learned French and chemistry (two things that most people would have absolutely no use for in their day-to-day lives) but not even a whisper of psychology. This should change, but since it hasn’t, I will take another swing at dispelling a common myth I repeatedly hear in practice.
You cannot have Bipolar disorder if you are abusing drugs.
I know, “But that’s what my (fill in the blank healthcare provider) said I have!” Well, I’m here to tell you that this is wrong. Here’s why:
You can’t technically have both going on at the same time, per the DSM. The reason for this is simple:
If you are currently abusing drugs, then you cannot say with any degree of certainty that any symptoms you are experiencing are not directly related to the drugs you are abusing. Feeling manic after an all nighter of meth? Feeling down the next couple of days? These mood swings on the surface appear to resemble the ups and downs in Bipolar, but symptoms must be caused by the presence of the disorder itself. When drugs are causing the symptoms, what we have here is a drug problem. Stop the drugs and see if the symptoms persist.
There’s a lot of confusion out there. Most of it is nobody’s fault in particular. Education in psychology is pretty sparse, especially in pre-college public education. In fact, I never even had the opportunity to have a class on the subject until I got to college. In high school we learned French and chemistry (two things that most people would have absolutely no use for in their day-to-day lives) but not even a whisper of psychology. This should change, but since it hasn’t, I will take another swing at dispelling a common myth I repeatedly hear in practice.
You cannot have Bipolar disorder if you are abusing drugs.
I know, “But that’s what my (fill in the blank healthcare provider) said I have!” Well, I’m here to tell you that this is wrong. Here’s why:
You can’t technically have both going on at the same time, per the DSM. The reason for this is simple:
If you are currently abusing drugs, then you cannot say with any degree of certainty that any symptoms you are experiencing are not directly related to the drugs you are abusing. Feeling manic after an all nighter of meth? Feeling down the next couple of days? These mood swings on the surface appear to resemble the ups and downs in Bipolar, but symptoms must be caused by the presence of the disorder itself. When drugs are causing the symptoms, what we have here is a drug problem. Stop the drugs and see if the symptoms persist.
In my practice, I like to see sustained drug abstinence for 6 months straight before I would even consider an official diagnosis of anything else. Even after 6 months if symptoms are persistent, I’m still going to be wondering if the damage done to the brain by the drug abuse is what is causing the symptoms. So in this case, what we would have is “drug induced” and then fill in the blank for the disorder.
So why are a portion of mental health practitioners so quick to slap a Bipolar diagnosis on someone? There’s quite a number of reasons unfortunately.
One reason is that they are just lazy. In a managed care setting (i.e. a volume customer setting usually populated by high percentages of Medicaid patients) healthcare practitioners are not afforded the proper time necessary to be able to accurately diagnose someone. These managed care companies are not paid well by the bargain basement insurance companies they serve, and the patients have a tendency to no-show their appointments, so in order to survive they have to fill up their walls with as many patients as possible.
Worse, they are forced to give some sort of diagnosis by the patient’s insurance. Worse still, those insurance companies (especially Medicaid HMO’s) will decree that a patient has to have a certain subset of disorders (usually either Major Depression, Bipolar, or Schizophrenia) or else they refuse to pay for services.
So rather than turn someone away who might actually need help, a managed care organization may slap a filler diagnosis that may not be completely appropriate just for the purposes of getting paid (unfortunately we can’t live on love alone) and making sure people are getting help who need it. In a nutshell, managed care is not good for anyone. It’s basically a giant disaster.
Best practices warrant that we try to refrain from giving out a diagnosis until we have seen a patient at least a couple of times. Maybe it’s possible that the person is telling us about their ups and their downs, and not telling us about their drug use. But then later on in therapy they decide to spill the beans, but we already gave them a diagnosis of Bipolar. Not that this cannot be changed after the fact, but the diagnosis informs our treatment, and if the diagnosis is inappropriate or just plain wrong, that patient is not going to get the kind of care that they need.
Another reason is because some mental healthcare practitioners may just not be educated enough about the disorder. There’s one primary thing that we all need to understand. Bipolar disorder is organic. It is a regulatory problem in the brain and how the brain directs different neurotransmitters, thus making you feel sad or depressed. Because we know that this disorder is organic, we must be aware that Bipolar and its symptoms of mania and depression are not caused by environmental factors. Said another way, if your happiness and sadness is caused by something, then we can quickly rule out Bipolar. The mood swings of this disorder occur independent of whatever is going on in the world. So if you are usually “really happy” but then get “really depressed when something terrible happens,” that isn’t Bipolar.
So make sure that if you have been diagnosed with Bipolar, or if you are a practitioner thinking that the patient sitting in front of you might have it, make sure that you have all the facts before you begin treatment. Bipolar disorder requires a very specialized sort of treatment which can work wonders for the person receiving it, but we must always be leery of over diagnosis as well as diagnosis that might be better accounted for by something else. In my practice, I like to see sustained drug abstinence for 6 months straight before I would even consider an official diagnosis of anything else. Even after 6 months if symptoms are persistent, I’m still going to be wondering if the damage done to the brain by the drug abuse is what is causing the symptoms. So in this case, what we would have is “drug induced” and then fill in the blank for the disorder.
So why are a portion of mental health practitioners so quick to slap a Bipolar diagnosis on someone? There’s quite a number of reasons unfortunately.
One reason is that they are just lazy. In a managed care setting (i.e. a volume customer setting usually populated by high percentages of Medicaid patients) healthcare practitioners are not afforded the proper time necessary to be able to accurately diagnose someone. These managed care companies are not paid well by the bargain basement insurance companies they serve, and the patients have a tendency to no-show their appointments, so in order to survive they have to fill up their walls with as many patients as possible.
Worse, they are forced to give some sort of diagnosis by the patient’s insurance. Worse still, those insurance companies (especially Medicaid HMO’s) will decree that a patient has to have a certain subset of disorders (usually either Major Depression, Bipolar, or Schizophrenia) or else they refuse to pay for services.
So rather than turn someone away who might actually need help, a managed care organization may slap a filler diagnosis that may not be completely appropriate just for the purposes of getting paid (unfortunately we can’t live on love alone) and making sure people are getting help who need it. In a nutshell, managed care is not good for anyone. It’s basically a giant disaster.
Best practices warrant that we try to refrain from giving out a diagnosis until we have seen a patient at least a couple of times. Maybe it’s possible that the person is telling us about their ups and their downs, and not telling us about their drug use. But then later on in therapy they decide to spill the beans, but we already gave them a diagnosis of Bipolar. Not that this cannot be changed after the fact, but the diagnosis informs our treatment, and if the diagnosis is inappropriate or just plain wrong, that patient is not going to get the kind of care that they need.
Another reason is because some mental healthcare practitioners may just not be educated enough about the disorder. There’s one primary thing that we all need to understand. Bipolar disorder is organic. It is a regulatory problem in the brain and how the brain directs different neurotransmitters, thus making you feel sad or depressed. Because we know that this disorder is organic, we must be aware that Bipolar and its symptoms of mania and depression are not caused by environmental factors. Said another way, if your happiness and sadness is caused by something, then we can quickly rule out Bipolar. The mood swings of this disorder occur independent of whatever is going on in the world. So if you are usually “really happy” but then get “really depressed when something terrible happens,” that isn’t Bipolar.
So make sure that if you have been diagnosed with Bipolar, or if you are a practitioner thinking that the patient sitting in front of you might have it, make sure that you have all the facts before you begin treatment. Bipolar disorder requires a very specialized sort of treatment which can work wonders for the person receiving it, but we must always be leery of over diagnosis as well as diagnosis that might be better accounted for by something else.
You cannot have Bipolar disorder if you are abusing drugs.
I know, “But that’s what my (fill in the blank healthcare provider) said I have!” Well, I’m here to tell you that this is wrong. Here’s why:
You can’t technically have both going on at the same time, per the DSM. The reason for this is simple:
If you are currently abusing drugs, then you cannot say with any degree of certainty that any symptoms you are experiencing are not directly related to the drugs you are abusing. Feeling manic after an all nighter of meth? Feeling down the next couple of days? These mood swings on the surface appear to resemble the ups and downs in Bipolar, but symptoms must be caused by the presence of the disorder itself. When drugs are causing the symptoms, what we have here is a drug problem. Stop the drugs and see if the symptoms persist.
There’s a lot of confusion out there. Most of it is nobody’s fault in particular. Education in psychology is pretty sparse, especially in pre-college public education. In fact, I never even had the opportunity to have a class on the subject until I got to college. In high school we learned French and chemistry (two things that most people would have absolutely no use for in their day-to-day lives) but not even a whisper of psychology. This should change, but since it hasn’t, I will take another swing at dispelling a common myth I repeatedly hear in practice.
You cannot have Bipolar disorder if you are abusing drugs.
I know, “But that’s what my (fill in the blank healthcare provider) said I have!” Well, I’m here to tell you that this is wrong. Here’s why:
You can’t technically have both going on at the same time, per the DSM. The reason for this is simple:
If you are currently abusing drugs, then you cannot say with any degree of certainty that any symptoms you are experiencing are not directly related to the drugs you are abusing. Feeling manic after an all nighter of meth? Feeling down the next couple of days? These mood swings on the surface appear to resemble the ups and downs in Bipolar, but symptoms must be caused by the presence of the disorder itself. When drugs are causing the symptoms, what we have here is a drug problem. Stop the drugs and see if the symptoms persist.
In my practice, I like to see sustained drug abstinence for 6 months straight before I would even consider an official diagnosis of anything else. Even after 6 months if symptoms are persistent, I’m still going to be wondering if the damage done to the brain by the drug abuse is what is causing the symptoms. So in this case, what we would have is “drug induced” and then fill in the blank for the disorder.
So why are a portion of mental health practitioners so quick to slap a Bipolar diagnosis on someone? There’s quite a number of reasons unfortunately.
One reason is that they are just lazy. In a managed care setting (i.e. a volume customer setting usually populated by high percentages of Medicaid patients) healthcare practitioners are not afforded the proper time necessary to be able to accurately diagnose someone. These managed care companies are not paid well by the bargain basement insurance companies they serve, and the patients have a tendency to no-show their appointments, so in order to survive they have to fill up their walls with as many patients as possible.
Worse, they are forced to give some sort of diagnosis by the patient’s insurance. Worse still, those insurance companies (especially Medicaid HMO’s) will decree that a patient has to have a certain subset of disorders (usually either Major Depression, Bipolar, or Schizophrenia) or else they refuse to pay for services.
So rather than turn someone away who might actually need help, a managed care organization may slap a filler diagnosis that may not be completely appropriate just for the purposes of getting paid (unfortunately we can’t live on love alone) and making sure people are getting help who need it. In a nutshell, managed care is not good for anyone. It’s basically a giant disaster.
Best practices warrant that we try to refrain from giving out a diagnosis until we have seen a patient at least a couple of times. Maybe it’s possible that the person is telling us about their ups and their downs, and not telling us about their drug use. But then later on in therapy they decide to spill the beans, but we already gave them a diagnosis of Bipolar. Not that this cannot be changed after the fact, but the diagnosis informs our treatment, and if the diagnosis is inappropriate or just plain wrong, that patient is not going to get the kind of care that they need.
Another reason is because some mental healthcare practitioners may just not be educated enough about the disorder. There’s one primary thing that we all need to understand. Bipolar disorder is organic. It is a regulatory problem in the brain and how the brain directs different neurotransmitters, thus making you feel sad or depressed. Because we know that this disorder is organic, we must be aware that Bipolar and its symptoms of mania and depression are not caused by environmental factors. Said another way, if your happiness and sadness is caused by something, then we can quickly rule out Bipolar. The mood swings of this disorder occur independent of whatever is going on in the world. So if you are usually “really happy” but then get “really depressed when something terrible happens,” that isn’t Bipolar.
So make sure that if you have been diagnosed with Bipolar, or if you are a practitioner thinking that the patient sitting in front of you might have it, make sure that you have all the facts before you begin treatment. Bipolar disorder requires a very specialized sort of treatment which can work wonders for the person receiving it, but we must always be leery of over diagnosis as well as diagnosis that might be better accounted for by something else. In my practice, I like to see sustained drug abstinence for 6 months straight before I would even consider an official diagnosis of anything else. Even after 6 months if symptoms are persistent, I’m still going to be wondering if the damage done to the brain by the drug abuse is what is causing the symptoms. So in this case, what we would have is “drug induced” and then fill in the blank for the disorder.
So why are a portion of mental health practitioners so quick to slap a Bipolar diagnosis on someone? There’s quite a number of reasons unfortunately.
One reason is that they are just lazy. In a managed care setting (i.e. a volume customer setting usually populated by high percentages of Medicaid patients) healthcare practitioners are not afforded the proper time necessary to be able to accurately diagnose someone. These managed care companies are not paid well by the bargain basement insurance companies they serve, and the patients have a tendency to no-show their appointments, so in order to survive they have to fill up their walls with as many patients as possible.
Worse, they are forced to give some sort of diagnosis by the patient’s insurance. Worse still, those insurance companies (especially Medicaid HMO’s) will decree that a patient has to have a certain subset of disorders (usually either Major Depression, Bipolar, or Schizophrenia) or else they refuse to pay for services.
So rather than turn someone away who might actually need help, a managed care organization may slap a filler diagnosis that may not be completely appropriate just for the purposes of getting paid (unfortunately we can’t live on love alone) and making sure people are getting help who need it. In a nutshell, managed care is not good for anyone. It’s basically a giant disaster.
Best practices warrant that we try to refrain from giving out a diagnosis until we have seen a patient at least a couple of times. Maybe it’s possible that the person is telling us about their ups and their downs, and not telling us about their drug use. But then later on in therapy they decide to spill the beans, but we already gave them a diagnosis of Bipolar. Not that this cannot be changed after the fact, but the diagnosis informs our treatment, and if the diagnosis is inappropriate or just plain wrong, that patient is not going to get the kind of care that they need.
Another reason is because some mental healthcare practitioners may just not be educated enough about the disorder. There’s one primary thing that we all need to understand. Bipolar disorder is organic. It is a regulatory problem in the brain and how the brain directs different neurotransmitters, thus making you feel sad or depressed. Because we know that this disorder is organic, we must be aware that Bipolar and its symptoms of mania and depression are not caused by environmental factors. Said another way, if your happiness and sadness is caused by something, then we can quickly rule out Bipolar. The mood swings of this disorder occur independent of whatever is going on in the world. So if you are usually “really happy” but then get “really depressed when something terrible happens,” that isn’t Bipolar.
So make sure that if you have been diagnosed with Bipolar, or if you are a practitioner thinking that the patient sitting in front of you might have it, make sure that you have all the facts before you begin treatment. Bipolar disorder requires a very specialized sort of treatment which can work wonders for the person receiving it, but we must always be leery of over diagnosis as well as diagnosis that might be better accounted for by something else.
Chase Chick MPA LPC is CEO and co-founder of Beyond the Gray Sky, whose brands include Pursuit of Happiness, Dallas Psychology Review, and Luxe Media Productions.
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