Substance abuse problems or Bi-Polar?

[Audloe]

Our 20 year old son, Stephen, was just released from a rehab facility for 21 days for substance abuse issues. He began drinking alcohol and smoking pot when he was only 16 years of age and in the past year, (in addition to the marijuana and alcohol) has used Cocaine, Ecstacy, and other prescription drugs.

The counselors at the facility said that they believe he is an addict. While I don't deny he has a substance abuse problem, I, as his mother, am concerned that he also has Bi-polar
disorder. My younger sister was diagnosed with BD several years ago and I suspect my father, (who is deceased) also had the disorder.

Stephen is sometimes calm, funny, bright, but can become loud, angry, extremely impulsive, rebellious, and immature for his age
in a matter of minutes.

I have talked with several close friends who have provided me with information and advice. A few are recovering alcoholics and addicts but several more are professional people in the medical field. A close friend of ours who s a Psychiatrist has suggested the possibility that Stephen may quite possibly have a "dual diagnosis" of addictions as well as Bi-polar disorder.He said that often the symptoms overlap and are often confused by substance abuse counselors. He has not observed Stephen as an adult because he lives in another state but said that Stephen could have BD.

In the rehab facility, the Psychiatrist did not want to consider BD because he agreed with our Psychiatrist friend that since Stephen had been abusing drugs so recently, it would be difficult to diagnose him as having BD.

My questions are:

1)Is it common for people to be misdiagnosed as being alcoholics or addicts while they instead are suffering from Bi-polar disorder or another personality disorder?

2)How are the symptoms different?

3)What would YOU recommend if I were to send Stephen to you?
and how would you treat a person with BD who also abuses drugs
and alcohol?

4)My sister, who only had one manic attack in her early 30's, was placed on Lithium and is doing well years later. She never had the wild "swings" that rehab counselors tell us Stephen would experience if he were indeed considered to have BD. I still
have the feeling because of years of observing impulsive, sporadic and odd behavior with Stephen, that he may have BD. Would he HAVE to have the frequent "swings" to be considered
as bi-polar?

5)I remember from my Psyc classes in college that the DSM IV
is used to determine the presence of Bi-polar. Is there another test that would show BD?

6) Are there some good books, websites, and information that you could recommend to me to help us with this issue?

I thank you very much for your time.

[Roger Gould, M.D.]

A lot of very good questions. First, the fundamental. It is quite common for people who have alcoholism to be predisposed to alcoholism because of their immaturity, mood swings, and other inability to manage and monitor their emotions. Whether he qualifies for the official diagnosis is really immaterial at the present, because the immediate first thing to treat is the alcoholism.  Then if the moods persist with sobriety, then the diagnosis will be clear, and the treatment for bipolar should start.  Some may argue that you treat the bipolar right away if it is suspected, and that will make the alcohol treatment easier. I don't agree with that approach, because first your son has to be committed to stop using drugs and start using his intelligence to make his life work.  Re books and websites, I don't have any to recommend because I don't track them, but I am sure there is more than enough information on the web, or at the government site for mental health, that being the most reliable..