Q:  Percentage of BP People Who Self-medicate?  

     
My son is bipolar, ADHD, and has a drug abuse problem. I am looking for any current statistics on the percentage of bipolar diagnosed persons and it's relationship to drug abuse. Statistics I have found state that 60% of bipolar persons will self-medicate with street or prescription drugs and/or alcohol. I also took my son to a psychiatrist who refused to prescribe mood stabilizing drugs until he was "clean" for 6 months. Is this a normal standard of care?
                

Dear Rae -- 
Right, the figure on co-occurring substance use I usually see is 50% of folks who have bipolar disorder.  Now, if your son clearly has bipolar disorder symptoms even when he's not using something, and that has been well established prior to his current use of whatever it is, then I think most psychiatrists would proceed to treat even while he's using in the hopes that the medications might increase his likelihood of getting and staying clean -- but not all would.  I'm not sure if this has been established at the "standard of care" level.  But in my area, if he was admitted to a psych inpatient unit (where I can see what other psychiatrists are doing), and the history was clear as above, I'm sure he'd get mood stabilizer treatment right off the bat.  

If the history was not so clear; and if this is being done on an outpatient basis, then I'm not so sure what other psychiatrists would do.  I can tell you that I routinely start mood stabilizers while people are using with the hope it will help them get off "their" stuff -- but of course one has to be careful about superimposed effects, etc.  I will fairly frequently do that even if it isn't crystal clear that the symptoms are due to bipolar disorder, versus due to substance use; but I may be more of an outlier in that respect. 

Dr. Phelps

Published March, 2004