“Health is not valued until sickness comes.” Thomas Fuller
I spent so much time and energy striving for stability in my early years with bipolar disorder that I ignored my physical health, and, unfortunately, I downright abused it. I am not intending to provoke fear about substance use disorder and its strong correlation to bipolar disorder as I know from experience that scare tactics do not work. Warning labels have been on cigarette packages for twenty-five years, yet people still smoke. I am simply wanting to relay my experience with substance use disorder in the hope that I can prevent someone from ending up like me. I have had an arduous, decades-long journey with bipolar disorder, finally arriving at my destination of achieving recovery, only to have poor physical health in my golden years.
I have had around fifteen psychiatrists over my thirty-two years as someone living with bipolar disorder: so many because quite a few psychiatrists have been in my life for only short periods of time. Of those psychiatrists, only one warned me that I was twice as likely to die from heart attack or stroke than the average person and that I would also have a life expectancy of ten to fifteen years less than the general population. Suicide and accidents contribute to lowered life expectancy among those with bipolar disorder as does substance use disorder. The average life expectancy, here in Canada, is eighty-two years so it does not bode well for me at age sixty-seven; sometimes it feels as though there is a gun to my head. Since less than seven percent of all my psychiatrists warned me about these grim statistics, it is possible your psychiatrist or doctor has not informed you.
Up to sixty percent of those with bipolar disorder have abused substances at one point in their lives. I am one of the casualties. I started collecting the nails to build my coffin decades ago.
I had many maladaptive coping mechanisms whenever I was in the throes of a depressive or manic episode—alcohol, food, cigarettes, and, to a lesser extent drugs—but cigarettes were my greatest love.
Nicotine produced an immediate rush of pleasure and relaxation, and so I smoked repeatedly to self-medicate and recreate those brief moments of calm, especially in times of hardship. People with bipolar disorder are almost four times as likely to smoke compared to the general population and it is my experience that we also smoke more when we do smoke. I smoked a pack a day for 35 years and two and a half packs when I had full blown mania. Since it takes approximately six minutes to smoke a cigarette, at my peak, I was smoking five hours a day. This was by far my hardest addiction to beat. I am embarrassed to admit that I even smoked in a stupor while in bed which resulted in numerous burn holes in my mattress, flirting with death.
Such is the power and reality of addiction.
It is widely known that cigarette smoking can cause heart attack and stroke, related cancers, and Chronic Obstructive Pulmonary Disease (COPD) which all contribute to an early demise. I was tempting fate. Even though I managed to quit smoking sixteen years ago smoking has a nasty habit of sabotaging your life decades later. I hear the early warning signs of COPD whispering to me at night, as it moves in fast, beckoning me to join it in death’s embrace and challenging me to a race I shall never win.
Alcohol was the next substance I abused, drinking to excess on my own. I used it as a shield as I thought it protected me from the onslaught of depressive symptoms. I couldn’t have been more wrong. Alcohol is a depressant, so using it often backfired, intensifying my negative emotions, leaving me to sink in deep water with waders on.
My descent into alcohol dependency was swift. My two young children had gone to live with their father permanently in a distant city precipitating my decline. I was then hospitalized for depression for two and a half months after which my drinking began in earnest. I was a forty-four-year-old mother who’d lost her identity and was inconsolable. Despair, regret, shame, and grief flooded my life leaving me feeling alone and vulnerable, and I turned to booze in search of comfort and oblivion. After my children left, I frequented my neighbourhood bar drinking alone on the same barstool night after night anesthetizing myself with rum and coke. You know you have a problem with alcohol when you step inside your local watering hole and, before you even sit down, the bartender has your drink of choice waiting for you on the counter.
I threw my internal clock completely out of whack by living in another time zone for a few months falling asleep at 5:00 am and waking up to a hangover at three in the afternoon; and occasionally a pick-me-up drink. I would listen to the dark stories of my mind in a continuous loop drinking very late into the night while watching hours of mindless infomercials; peering bleary-eyed at the apartment building across the lane—with the same three apartments always bathed in light, their occupants wide awake—wondering if they were sobbing and dead inside like me.
I also abused alcohol when I had full-blown mania, but for different reasons. On occasion I started drinking as early as ten in the morning as an act of complete abandonment and exuberance, looking for fun and surrendering to the high. Having mania felt like I was living life to the fullest; a life driven by hedonism and excess.
I was only able to stop abusing alcohol once my finances had me in a stronghold with my overdraft at its limit and both my line of credit and credit cards maxed out. I was receiving just seventy percent of my salary on long-term disability, for the six months I was supposedly convalescing at home and drinking at the bar each night proved to be a very expensive pastime. I was going into the red each month struggling to make my mortgage payments and felt I had lost too much in life to lose my condo as well. Once I had a reason to quit, I was able to stop but it required extensive treatment that helped me address my past and present trauma and unearth a self-esteem so low it left me without regard for my physical health. I also had to learn to embrace unconditional self-love if the goal were to treat my body with the respect it deserved. I had been consumed by self-loathing far too long.
I wasn’t paying heed to my psychiatrist’s warning about my future health problems and shortened lifespan as alcohol can also lead to cardiovascular disease and an early death through cancers and liver disease. I abstained from alcohol for ten years once I was living well with bipolar disorder but, two years ago, I found I could drink in moderation consuming two glasses of wine per week as per Canada’s guidelines or having a few glasses at a dinner party; never craving an extra glass once I returned home or the following day. I see this as proof that my alcohol use disorder was caused by instability and mood swings.
I have experimented with a variety of addictive substances, which brings me to my experience with illicit drugs. Cocaine was my preferred drug because it magnified the symptoms of mania, but it can negatively affect the cardiovascular system and cause premature deaths due to fatal overdoses. I developed a taste for cocaine, but never a physical dependence, as was the case with my love affair with cigarettes. I only ever did cocaine in times of mania, forming a fellowship with other likeminded drug users, because it was a highly social activity for me compared to my self-imposed exile in times of depression.
And finally, I abused food by bingeing and treating food as a tranquilizer, cramming enough food into my body to suppress all the pain and sorrow. I would consume thousands of calories in one sitting which resulted in me developing obesity, pre-diabetes, and metabolic syndrome. All three can increase the risk of heart attack and stroke and untimely death. I knew I was destroying my health, but I seemed incapable of stopping. Binge eating proved to be the most enduring of my addictions and one that stayed with me for over forty years until age sixty. My self-destruction knew no ceiling during all those years of overeating.
I was able to stamp out all my addictions individually over time and these days I am completely addiction free.
It is important to be honest with yourself and seek help for your addictions. I regret that I didn’t. Shame prevented me from seeking assistance, even though I knew my psychiatrist could not help me if he wasn’t aware of the extent of my clandestine activities. Furthermore, my psychiatrist at the time had made several judgemental remarks during the course of treatment that shut down any future open communications I may have had with him.
If you are abusing substances, it’s quite possible that you are not coping well and are self-medicating like I was. In my opinion, self-medication may be a sign that your bipolar disorder is not well controlled and perhaps your medication needs adjusting.
It is also imperative for people with bipolar disorder to be proactive about their physical health and request screening for the medical illnesses that affect us as a group. The present-day focus on psychotherapy and the administering of psychotropic medicines is not enough. Holistic medical care, for both the mind and body, is essential if our tendency is to die earlier than the rest of the population.
My greatest regret is that I treated my body as if it came with an unlimited warranty without reading the disclaimer in fine print stating that the guarantee would be null and void in the event of misuse.
Louise Dwerryhouse, a retired social worker, who worked in Canada and the UK, is an advocate, and mental health blogger on “lived experience” living in Vancouver, British Columbia. She was diagnosed with bipolar I disorder late in life, over 30 years ago at the age of thirty-five, and has been living well with the disorder for 10+ years. She writes to those alone, frightened and traumatized by volatile mood swings such as she had in her early days post-diagnosis. Louise tries to lead by example, by sharing her journey to recovery, showing it is possible to live well with the disorder. Her dream is to see a society centred on acceptance, inclusion and less stigma in her lifetime.