What advice would you give to a dually diagnosed person about stopping drinking at the cost of increasing symptoms of depression or bipolar disorder? I stopped drinking 10 years ago, and 6 months later a living hell of bipolar disorder was exposed.

Alcohol is probably the world’s oldest treatment for mood disorders. And like other ancient treatments (leeches, arsenic, boring holes in the skull), it usually does more harm than good. Alcohol remains a popular “treatment” because the immediate effects—like reducing anxiety and calming agitation—can seem helpful. But those immediate effects are deceiving. Regular use leads to tolerance and dependence, and that makes anxiety, agitation, and depression worse. Once that tolerance or dependence develops, stopping is difficult and sometimes even dangerous. Dependence literally means that stopping drinking can temporarily increase anxiety, agitation, or depression. That withdrawal period can make it seem like alcohol was really helping—when it was really making things worse.

The best advice I can give about self-medicating with alcohol is to not start down that path. But that advice isn’t very helpful to someone who has been using alcohol heavily and may have already developed tolerance or dependence. If you’re in that situation, the best advice I can give is:

  • Don’t hide it. Being honest with people in your life (including your health care providers) about your use of alcohol means that they can support you in making changes. If you feel ashamed or embarrassed, you’re certainly not alone. But, telling people is the way out of that shame or embarrassment.
  • Build a sober support network. If your daily routines or social life are built around using alcohol, you’ll need to build a support network that doesn’t involve drinking. That network might include organized meetings such as Alcoholics Anonymous. It will usually include social activities that don’t involve alcohol. Think about the people, places, times, and situations connected with your drinking and ask yourself, “What are healthier alternatives for me?”
  • Look for treatments that work for you. Specific kinds of counseling or therapy are proven to help people reduce or quit drinking. Some medications can reduce craving for alcohol and make it easier to quit.
  • Learn from your mistakes. Most people who successfully stop or cut down on drinking will have slips or relapses along the way. If that happens, try to understand where things went off-track and how you might react differently next time.  Feeling guilty or blaming yourself often doesn’t help with that understanding. If guilt or shame cured alcohol problems, nearly everyone with alcohol problems would have been cured long ago!

About the Doc

About the Doc

Greg Simon, MD, MPH, is a psychiatrist and researcher at  Kaiser Permanente Washington Health Research Institute in Seattle. His research focuses on improving the quality and availability of mental health services for people living with mood disorders, and he has a specific interest in activating consumers to expect and demand more effective mental health care.

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