Q:  Bipolar or Long Term Residual from Drug Use?

35 y/o bipolar d/o.  I have been in recovery from alcohol/drugs for 3 yrs now.  Was heavy methamphetamine and alcohol user on/off since I was 16 yrs. old.  I have delusions and am paranoid....still in process of finding right meds.   How do the professionals know if what I have is really bipolar or a long term residual from the heavy use of methamphetamine?  For some reason, I want to know.
 

Dear Michelle -- 
Very understandable that you'd want to ask, and it's a very good question, as it bears directly on how you treat what you've got:  can you expect that the paranoia and delusional stuff will stop if you get the bipolar disorder fully under control? or might they continue when there are no other bipolar symptoms (such as mood problems, sleep problems)?  I guess that's how I'd look at it:  first get the bipolar under control, then see what's left.  I have some patients with similar histories, and have asked basically the same question:  am I having trouble controlling their bipolar disorder, or are they having some sort of after-effects from all the drug use?  At some point it really comes down to treating the symptoms, as long as the other reasonably possible explanations for the symptoms that actually have treatments (some medical conditions your primary care doctor would know to look for, especially once the bipolar stuff is controlled) have been ruled out, e.g. an adrenalin-producing tumor -- things we wouldn't want to miss underneath the rest of the symptoms.  

Dr. Phelps

Published July, 2004