A new issue on top of everything...

[Coping11]

We found out a few days ago that daughter has started using amphetamines. We confronted her, and she of course doesn't think it's a problem. Her therapist said very correctly that amphetamines suppress appetite and are very appealing for anorexics (especially extremely impulsive ones like daughter). She lives at home right now, and told her that she can't stay here if she continues using. She went ballistic, threatening suicide, and we called 911. ER released her with referral to an outpatient program (she already attends one 3 days a week although she started slacking).Right now she is staying with loser boyfriend who is unemployed after getting kicked out of military.

I am tired. We've been through a lot with her since she was 12. She's spent a year at a therapeutic boarding school, several psychiatric hospitalizations and inpatient stays in eating disorders units, camps, psychiatrists, and what not. We've never kicked her out, mostly because we are afraid her eating disorder will get worse.

Has anyone had children with bipolar/eating disorders who have developed substance abuse issues? How did you deal with the complex interactions between all these issues? What do we do now?

 

[InsaneCdn]

Hugs, Coping.
That's a difficult combination.
There may be more that has gone on in the background than what you know. Anorexia and bulimia can be triggered by abuse - often, from someone outside the home (teacher, coach, neighbor, family member of a friend...) If that is the case - and you will only make things worse by asking directly - then both the medical conditions and the substance abuse may have a related "context".

Bi-polar... I'm guessing she isn't medications-compliant and/or hasn't found the right medication yet? Because unmedicated bi-polar is very ugly.

 

[GoingNorth]

Not to mention that amphetamines or other stimulant medications are a real no-go unless the patient has a history of LONG-TERM stability on medications for bipolar first.

I was additionally diagnosed as depression/ADHD and trialed on Ritalin. I only took one dose.

I got so badly "spun" on it that the only thing that kept me sane was knowing it would wear off in a few hours.

It did, but crashing off the Ritalin threw me into a nasty depression that lasted several weeks.

I DO have ADHD, but 2 psychiatrists since do not recommend that I take medication for it. It was hard enough to get me stable enough to tolerate a SSRI in small doses.

I cope bymaking notes, using an online organizer, etc, and the medications I take for bipolar help some with the ADHD sx.

Other than that, I'm just very spacey, have lousy executive function (why I write/type everything down), and am prone to a lot of fidgeting.

Anyway, you HAVE to get her away from the amphetamines if you can. They can be deadly combined with anorexia or any illness that impairs nutrition and CNS function.

It also makes a difference as to what amphetamines she is taking. I am going to take a leap and say that, especially at her age, she is using Adderall, which is a time release amphetamine sold widely on the street as well as in schools. In addition to legit Adderall, there is a lot of "street" Adderal made in China and India.

Hopefully it is Adderal as it is easier to get off of that than methamphetamine.

Also, ALL amphetamines are cardio and neuro toxic, the toxicity increasing with frequency and strength of dosing.

Amphetamines also stunt growth and development. I think there is even a warning on RX packages to this effect.

At the very least, get her into a doctor and get an EKG run, TELL the doctor what is going on, and take it from there.

The drug use, anorexia, and bipolar, all have to treated as a "whole", and the underlying cause(s) treated.

That's going to be very difficult, and i don't know how to advise you to go about finding treatment.

You do have dual-diagnoses centers that treat mental illness combined with addiction, but I don't know if they would accept a pt who also is anorectic.

 

[Nancy]

Hi Coping. Yikes, that's a difficult combo of disorders. I think GoingNorth gave you good advice. I wish I could be of more help. Her bi-polar dr has no suggestions?