Dual Diagnosis & VA
[Home] [Bipolar News] [Bipolar Disorder] [Medications] [Treatments] [Bipolar Disorder/Job/School] [Disabilities] [Ask the Doctor] [Ask David] [Self-Injury] [Personal Stories] [Graham's Column] [Steven's Column] [Storm's Column] [Columnist Archives] [Suicide] [Community Support] [Family Members] [Expressions] [Greeting Cards] [Books] [Awards] [Links & Rings] [About Us] [Contact Us]

 


Q:  Dual Diagnosis & VA


Dear Dr. Phelps,
How do I go about determining that drug addiction/alcoholism was secondary to (or a symptom of) Bipolar I. I know that up to 50% of BPD patients have addictions in their lifetime.  I am dealing with the VA and was treated in service for alcohol/substance abuse in the '70s but never heard of Bipolar until diagnosed by VA in '97.  Their position is drug/alcohol is willful misconduct unless secondary to (or a symptom of)a service connected illness.

My VA doctor has opined that I was most likely BP in service but what do I do about my Dual Diagnosis ? How do I connect the dots?  The VA may suggest I became Bipolar as a result of drug/alcohol misconduct.

Please advise a course of action concerning establishment of symptomology.  My VA doctor is supportive of my claim and is aware of my past and has agreed with a prior Dual diagnosis.

Thank You

 
Dear Mr. R' -- 
Perhaps we should split this into two aspects of the same question: first, the therapeutic issues; then the VA bureaucracy issues. 

Therapeutically, it's pretty straightforward: treat the bipolar part and see how much the substance use problem remains, then treat that as you need to (including aggressively if necessary). That's how I do it, and haven't had too much of things falling apart while I focused on the bipolar disorder.  However, some of my colleagues think that I underdiagnose substance use and underemphasize it's treatment.  In some folks, that could be true. 

As for the VA, at least you could cite the fact that there is no clear evidence that drug/alcohol misconduct causes bipolar disorder.  Bipolar Disorder is very strongly genetic.  Stresses, probably including substance use but probably also including military service and even just military training from what I know, are also recognized as "causing" bipolar disorder. 

Dr. Phelps


Published August, 2002

 

Bipolar World   1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014
Owners: 
Allie Bloom, David Schafer, M.Ed. (Blackdog)
Partners:  John Haeckel, Judith (Duff) 
Founder:  Colleen Sullivan
 

Email Us at Bipolar World

 

About Us  Add a Link  Advance Directives  Alternative Treatments  Ask the Doctor   Ask Dr. Plyler about Bipolar Disorder   Ask The Doctor/ Topic Archives  Awards  Benny the Bipolar Puppy  Bipolar Chat  Bipolar Children  Bipolar Disorder News  Bipolar Help Contract  Bipolar World Forums  Book Reviews  Bookstore  BP & Other mental Illness   Clinical Research Trials & FDA Drug Approval   Community Support   Contact Us  The Continuum of Mania and Depression   Coping   Criteria    Criteria and Diagnosis  Criteria-World Health Disabilities,  DSMV-IV   Dual Diagnosis  eGroups  Expressions (Poetry, Inspiration, Humor, Art Gallery, Memorials  Family Members   Getting Help for a Loved One who Refuses Treatment  Greeting Cards  History of Mental Illness  Indigo  Job and School  Links  Manage Your Medications  Medications   Medication and Weight Gain    News of the Day  Parent Chat  Pay for Meds  Personal Stories  Self Help  Self Injury  Significant Others  Stigma and Mental Health Law  Storm's Column  Suicide!!!  The Suicide Wall  Table of Contents   Treatments  Treatment Compliance  US Disability  Veteran's Chat  What's New?