I do not have a medical degree, nor a degree in psychology. I'm just a person who raised a son with bipolar disorder, and who reads a lot and searches for information and answers through every available outlet, for many years.
I made my comment about the ERs, because these doctors who throw this drug around could be creating a lifetime of hell in susceptible individuals..which may well run as high as 1 in 10, or more....and also, hell for their families. And that simply does NOT have to happen. Want to stop one major source of ultimate heroin addiction? Then stop throwing this drug into people's bodies when it is completely unnecessary.
Your question is actually incredibly complicated, and I do not want to open a Pandora's Box here. As a society we are severely lacking in any basic information in the public about neuro-biological brain disorders....and overall, as a society, don't WANT to know, and prefer to judge and put down and remain in the dark, ignorant, and doing negative things to people with an illness or disability. (Even on DU at times.) At least 1/3 want to think things like: why don't you get a job you lazy jerk I'm cutting your SNAP. Mankind being what they are, we define people by their diagnosis: people will say: he IS bipolar, and that is incorrect, dehumanizing, and destructive. He may HAVE bipolar disorder, but he ISN'T bipolar disorder, and that's not just semantics: it impacts and defines how we view other human beings in a most negative and destructive fashion. We don't categorize and identify diabetics by the function of the pancreas in an individual; we don't view them through that lens. But we as a society do that with neuro-biological brain disorders. NBD is the terminology we should be using. The term 'mental disorders' really does mean to so many people, 'hey why don't you just snap out of your depression', etc. It's not 'mental', as in a choice, or as in being reflective of someone's personality or character as a human soul. Bipolar is a neuro-biological, chemical, physical, electrical imbalance.
Ugh, this is so complicated, but at the same time, the only cure for how our society brands and discriminates against and punishes people for suffering with an NBD, is to use 'the hair of the dog'.
Before you read any of this, though, a few points are critical:
1. Science doesn't really know squat about how the human brain works. As the mother of a son with bipolar disorder, Obama's initiative to map the human brain meant more to me than many other things that he has done or could do.
2. Without knowledge, treatment of neuro-biological brain disorders is, really, a freaking guessing game. Throw something at the wall and see what sticks for a given individual. If you are lucky, something works.
3. The term bipolar should really be, 'bipolar spectrum'. To note that someone has a diagnosis of bipolar means exactly as much as saying someone has an injury to their arm. Hm, what does that mean? A scratch? Severe abrasion? Deep cut? Compound fracture? Amputation? It tells you nothing. That's what a diagnosis of bipolar tells you about any individual. And even if you have deep personal knowledge of that particular person, that still tells you absolutely nothing about what will effectively help that individual. We 'know nothing, John Snow'.
4.Part of that lack of knowledge and absolute uncertainty is because our genetics and biology are so complicated. It's not a matter of one gene causing one outcome, but most likely, many different genetic variants working in combination. Maybe there are 20, 50, 100 different factors, that may or may not be present in any given individual, and that may or may not be active in impacting that individual, depending upon both medical/chemical/electrical/biological stimulants, as well as social-type life events. If you are going to make a cake, you need flour, eggs, butter or oil, sugar, etc. But are you going to use 5 lbs of flour, or a few cups? A dozen eggs, or one or two? It's not just the 'ingredients', it's also how many of each one and what you do with them, how much heat is applied, and when, and in conjunction with other things, like do you mix the batter, or beat it, or just toss it all in a pan and bake it.
Other points:
1. Some recent genetic research has identified one specific genetic marker that is linked to depression, alcohol, and tobacco abuse. Two of the most common prescription drug assistants to kick the smoking 'habit', are in fact, anti-depressants: Chantix and Welbutrin. (Which is why I won't ever use them, even though I chain smoke and want to quit, because of the presence of bipolar in my family tree.) This is now an accepted 'fact'...but beyond the correlation, nothing more can be made of it at this time. It could be that in individuals without bipolar genetics, that smoking or alcohol use disrupts the chemical balance of the brain, and that with the use of Chantrix or Welbutrin and a withdrawal schedule, those people can quit smoking and go back to what there brain balances were before using alcohol or tobacco. It could be that for people who possibly have bipolar genetics, other outcomes, which can be permanent and negative/destructive, have been noted. (Like having a 'normal' life before the antidepressants, and after use, suffering from bipolar or committing suicide, etc.)
2. I think it is fairly safe to say that, in general, opiods are highly addictive.
3.There is a phrase 'dual diagnosis', which when used in reference to someone with bipolar disorder, means that the individual has both a drug addiction problem and suffers the torments of bipolar disorder. If you poke around online, you might see some statistics that I think are actually quite meaningless, about the high prevalence of a dual diagnosis with individuals with bipolar. What you need to understand is that this is only a high prevalence among individuals DIAGNOSED with biopolar... and the fact that someone has a drug addiction means they have been brought to the attention of medicine and science... whereas there are many, many more people who are somewhere on the spectrum of bipolar disorder, who are never diagnosed. The impacts can be very mild, not observable to others. So, these people aren't in the pool of those being used to determine the prevalence of dual diagnosis...so I find those statistics to be very overstated, because they are only including those people with a formal diagnosis of bipolar.
4. Science doesn't really know much beyond knowing that there is a sufficient link in a sufficient number of people, to have assigned the term 'dual diagnosis', and use that handle to indicate this situation.
5. There are discussions of 'what came first, the chicken or the egg', as far as the drug addictions and the bipolar responses. There are theories that using/abusing drugs can trigger underlying genetics, change the brains function, and result in a person who suffers (or suffers more severely) from bipolar episodes, who prior to the drug use/abuse, did not. But science doesn't really know. But what I know, as an informed chain smoker, is that my own brain has become dependent on nicotine for stimulation and to balance my emotional state... smoking impacts the relative balance of testosterone and estrogen in the body....stop smoking, your estrogen balance goes up... as a female, that means somethings to me, LOL....five hours without a cigarette, and I start crying... I HATE nictotine, HATE it.... What has happened is that my brain has ceased producing and balancing its own stimulants, and relies on nicotine to do that. If I go 5 hours without a cigarette, I can't focus, even when I try very hard. I quit cold-turkey for a week once, and crossed the double-yellow line twice, and since I had a minimum 45 minute commute to work, I decided to smoke again, before I killed myself or innocent others. Whatever nicotine does in my brain now, caffeine won't do for it. The point being, using chemicals / drugs can alter the functioning of your brain. I worry I might be permanently ADD now, though the slower withdrawals by cutting back on smoking does ease that fear a little...and make me realize how very dependent my brain is on this nasty tool of Satan. I can't use Ritalin or anything else, for the same concerns. (That's per a professional psychiatrist). These theories, that using a drug can alter the brains function, and perhaps permanently, and the fact that there is evidence of bipolar genetics in my family, are why I won't use Chantix or Welbutrin and many other prescription drugs. I won't take the risk of triggering a bipolar response... that could be permanent and exist after I stop use of the drug. I'd rather be quadriplegic, than suffer with bipolar, and I'm not exaggerating. My Mom lived in a wheelchair the last 25 years of her life, thanks to a drunk driver, and my son has suffered immeasurably for countless days of his life from bipolar disorder, which is on the severe end of the scale, for him. My Mom chose to be happy, to find happiness. My son has been robbed of any such possibility of choice too many days and years to count.
6. The flip side, which I have no doubt at all is true, is that people suffering from bipolar disorder, which can at times be 24/7 living hell of anguish like only those who have lived closely with this can know, do 'self-medicate' with street drugs. This is particularly true when they have not been diagnosed with bipolar, and therefore, aren't receiving any assistance or treatment. Say, a teenager. Teenage angst is one thing that can be really rough for many....now add bipolar disorder, and you ramp up the impact exponentially... and hey, here's Joe on the corner with something to help, and all your peers are doing it anyway... I'm hoping that down the line in the years, changes in the DSMV (psychiatric manual) will now prevent some of these tragedies from occurring. When my son was young, until he was an adult, actually, the DSMV would not allow for a diagnosis of bipolar until adulthood. That always seemed, pardon the pun, 'crazy' to me.... what that was saying was that after reaching adulthood, the human brain suddenly rewired itself, and began responding differently in its chemistry and electrical functioning... just 'because'. It made much more pragmatic sense to me, to view the situation as one where genetics, from birth, had given an individual a different blueprint of chemical and electrical responses, but that the social lens of childhood behavior, versus expectations as an adult (who was trying and failing at being independent), simply made behavioral differences from the norm in adulthood much more apparent and of concern. After my son was an adult, they finally changed this stance in the DSMV. My son and I were blessed, though, because I got him to a psychiatrist when he was in middle school, who treated him for bipolar, without actually formally diagnosing him as bipolar (which the DSMV wouldn't let him do.) My son has never been on street drugs, and has received relief and some normal life functioning by using prescription drugs that do help most of the time. Hundreds of thousands of others never got that care. Two of them are in my husband's extended family....both of them, first cousins, ended up using street drugs, committing crimes to support their habits, going to jail, and after almost 10 years of this, getting a diagnosis of bipolar disorder, and THEN receiving prescription treatments... but by now, their brains have been so impacted... actually, one of them just died in his jail cell on Christmas Day. If only he had been diagnosed 15 years ago or more, and received medical supervision and proper pharmaceuticals, maybe that poor young man would have had a life, and a life worth living. Or, 'chicken and egg', maybe the street drugs were the cause of the problem. I wasn't around when he was a child, so I don't have any idea...except that his first cousin made the same harmful choices and got the same results, too, giving some indication of a possible genetic connection.
So, that's just the tip of the iceberg. My concerns are that people in the ER can use that stuff, and end up with completely unexpected consequences that destroy a great deal of their lives, or even ends up ending their lives. I do know of one young woman who was put on opiod pain killers for pain from cancer... for months she could only get pain meds, and not the surgery she needed, while she waited for public medical assistance to come through.... she had just moved to another state, returning home to care for an ill parent, when she was diagnosed, and had not yet secured another job. Her tolerance built up very rapidly, and in the end, she ended up using heroin. Now she's battling to get off the methadone. Her life for 10 years has been complete hell. And she had no clue at all, when she first took that little prescription pill, of what it would do to her. She's not alone. And it just simply never had to happen. If we had Medicare for all, it would never have happened to her, in her case. But in how many others does this happen, just because the ER docs prescribe it like it was candy?
On Edit: I want to comment further on what I said above: "It's not 'mental', as in a choice, or as in being reflective of someone's personality or character as a human soul." There are other medical issues that can create a temporary change in mental state, functioning, things we might identify as 'personality'. For example, someone in need of thyroid medications that doesn't take them can display very different behaviors (in fact, before a diagnosis of bipolar is made, thyroid function must be checked.) Once they get the thyroid meds they need, they might seem to be completely different people in many ways. Well, when my son is stable on his meds, he is the sweetest, most loving person you could know. He is genuinely concerned not only for the welfare of those in his immediate circle, but also greatly concerned about issues impacting society at large (ie, a Democrat, LOL). But when the meds aren't working and need adjustment, he's not himself at all. He cares for no one and nothing, is surly, angry, and lashes out at everyone. And the difference isn't what some people think... for example, overuse of Ritalin in children can leave them totally doped up and limp... it's NOT that at all. The difference is far more complicated. My son's real personality and character, when his chemical/electrical/biological responses are out of whack, well his real self is buried under all the trauma and upheaval. I wish I could better explain that, and do so in a manner that really made this difference clear, to those who are so judgmental and damning...but I guess I can't... people like that quite often simply have their own mental issues requiring them to condemn, put down, and make life even worse for those suffering. Not to say you do, at all... it's just so very hard to discuss this stuff, and yet, I feel that I must, for that's the only way to make a change. Science, logic, and having a heart and the courage to speak.
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and is a typical white privilege response. My parents were born in 1924 & 1930 and grew up under Roosevelt and gave me a clue. A. Philip Randolph's repeated threats and engagement with Roosevelt eventually lead to that EO but not much else. The military and much of the rest of the country remained segregated and FDR wasn't about to budge. I.e., there is so much fantasy going on about FDR that it is truly remarkable.
