12 Steps to Stay On Drugs

The current version of this method is primarily for people who have the type of fun manias that are the stereotype of bipolar disorder. I’m working on a generic version of a 12 step model to stay on drugs for everyone, regardless of neurological / psychiatric disorder. However, as written, this piece may be of help to you regardless of what your condition is.Walking Away from Mania in Twelve Easy Steps
Hi, I’m Jerod and I’m a mania addict.

After what I’ve experienced lately, and giving it a lot of thought, I’ve come to the realization that the 12-step model of support group therapy is a damn good adjunctive treatment in addition to medications and whatever other therapy you might be doing. It’s not a replacement for either, it’s an addition to both. In reading some 12-step sites it’s dawned on me that I’ve been doing this on my own without knowing a damn thing about the 12-step program, other than being really annoyed by the passel of passive-aggressive Deadhead AA members my former next-door neighbor would have over twice a month. “Let go, let Jerry” read at least one bumpersticker on each of their cars. Ye Gods.

But if you’re reading this and you’re bipolar, somewhere around the bipolar 1 part of the spectrum, at least part of the time, ask yourself if you’re a mania addict as well.

There are many reasons why we don’t want to be med compliant. The meds suck! They change how much we weigh, they make our hair fall out, they make us sleep all the time, we can’t think straight anymore, we forget everything, we break out like it’s two weeks before the senior prom and we still don’t have a date, you can’t get it up with a forklift, food tastes funny now, ow! another goddamn kidney stone, on and on with the side effects. Plus we get to pay lots and lots of money for the privilege of feeling like shit. Why? So you’re not manic anymore. So we’re not smarter, sexier, more confident, more on top of things, more fun and just plain better than everyone else.bipolar mania

The point is, our selective memories act so we remember all the fun-fun-fun manias. So of course we don’t want to take the meds because we want to be our euphoric manic selves. There are even some dysphoric manias we’d like to be in. What? You don’t believe me? Rage, people, rage. Have you heard the term rageoholic? It’s not wholly some bit of psychobabble thrown at people, there is a core of truth in it. The power of true fury is a melange of potently addictive substances coursing through your system, both physical and psychological. Anyone who has met me can tell you that Andy Warhol could have wrestled me to the ground two rounds out of three, post-Valerie Solarnis. Yet I punched a hole through the wall of a house with my bare fist. I’ve destroyed rooms of furniture. No one messed with me in school, scrawny brainiac autistic teachers’ pet that I was because I sent three kids to the hospital who did mess with me. That was by the third grade. I don’t even know what happened, they started something then they were unconscious. Same with the hole in the wall and all the deceased furniture. That’s what true rage is like, you don’t remember the details. Just the feeling of power. It was always a struggle not to let it out.

There are alcoholics who never have a good time with booze, but they keep drinking. Could the same be true with mania? Could even the dysphoric manias be addictive? I don’t know.

But I’m convinced that the fun manias are addictive. Behavior can be addictive, that’s been proven. So it is doubly hard to stay on our meds, triply hard if we’re paying for them out of pocket. We have to fight with the side effects, we have to fight with the addiction to mania and we have the battle of the budget to pay for the damn things.

Now let’s discuss being mania addicts. Since my last breakthrough hypomania last month, the first in nearly a year, I’ve been giving a lot of thought on the subject of mania as addiction. If you’ve read my blog you saw that I did nothing about that hypomania, I just let it ride for two days because I’m a fucking addict. I can even see depression as being addictive, but it’s not my bag, despite accusations to the contrary. I just like to complain about it when I’m depressed because that helps me work through it. Anyway, the meds are great, the meds are necessary, we can’t fight mania without the meds. But the meds aren’t enough. We need to do something like the 12-Step program for mania. I know it reads weird, and it is basically replacing one addiction (“Keep coming back!”) for another, but the 12-Step addiction is basically harmless. Yeah, it can waste a lot of your time, and the people involved, while for the most part are really wonderful; well if you ever read Fight Club or saw the movie, that whole thing about people going to support groups for kicks and manipulating the members for sick pleasures? It’s not fictional. And the 12-Step groups attract the worst of that type. I know, I dated one. Her idea of fun was going from one meeting to another. And this was long before Fight Club. So 12-Step for bipolar, I can guarantee you a healthy percentage of sociopaths. But there is a way around that. Do the 12-step part on your own, or just one-on-one or in very small groups with people you trust. People you know from other bipolar support groups. Preferably online. It’s all doubly anonymous that way.

Anyway, we need the support of other people, people who have been through a lot of the same shit we’ve been through. This 12-Step stuff, you can do that by yourself. OK, if you have a soul of iron like I got from my father you can. There may even be a better model for dealing with addictive behaviors, it’s just that walking the 12-Steps is free and relatively effective, so that’s why I’m advocating it. It’s not the only way of dealing with addictive behavior. Just as there are a plethora of drugs to deal with bipolar, there are probably other ways of dealing with the behavioral aspects of just wanting to be manic again. I know you’re just itching to ruin your credit rating, destroy your relationships, pick up an STD, wreck your car, get injured in a bar fight and lose your job after you scream at your boss for not being able to see how simple the solution to all the problems are!!!

I just think the twelve steps are in need of a little tweaking for our situation. Sure, Affective Disorders Anonymous is applying the traditional twelve steps to bipolar and similar disorders, simply replacing “alcohol” with “our affective disorder,” but I honestly don’t think that they’ll work as written. And if you don’t like my adjustments, feel free to make some of your own. And that crap about not being able to progress from one step to the next? I wouldn’t worry about that too much. Once you get past step one, hit all the others as you see fit in whatever order you can deal with. Yes, the best way is in the order they are presented, but that is just not going to work for everyone. And you shouldn’t get held up because you can’t complete a step. Steps 4, 5 and 8 are truly difficult. So, here we go with the annotated 12-step program for mania addiction:

Step 1: Come to accept that the bipolar diagnosis is correct and that in our manic periods we have made a right mess of things. See, the thing is, we’re not completely powerless, and our lives are not utterly unmanageable. Now when you go into an AA group or website you are blasted with guilt at this point, and maybe you should be blasted with guilt about all the stupid, lives-destroying shit you’ve done when manic. However I think the side effects from the meds are better penance, and I was raised Catholic, so I know of what I write. As for the powerlessness and unmanageability, look, once we find the right doctor to prescribe the correct meds and as long as we stay med compliant, we have the power over the mania and we can keep our shit together. Don’t be fooled for one second that there won’t be breakthrough manias or that meds may not fail. But modern science is getting more modern by the day. It’s a struggle, but we can win. I’m not powerless over mania, but I’m not ignorant of the fact I’m fighting a powerful enemy. But you have to come to terms with the fact that you are bipolar and you have fucked things up when you were out of control during your manias. If you are not currently medicated, then you are powerless. You’re completely deluded if you think you have things under control. Get with the program. Right now.

Step 2: Come to believe that a power greater than ourselves can and will restore us to sanity. Indeed. Pharmaceutical companies, psychiatric research, clinical studies, doctors and therapists getting together and exchanging notes on what works and what doesn’t, potent molecules where 0.25mg of Risperdal can have so much impact on my life, those are all way more powerful than I am. All of that and more have gone a long way to restoring my sanity. Oh, hey, if you think that some sort of deity is involved as well, that works too. Prayer or some way of talking to the universe is great. In my weird hybrid Buddhist-Catholic-Pagan way I pray for the continued sanity of Mouse and me every morning. But $DEITY alone is not going to do it. Force of will alone is not going to do it. You need meds to do it and you need the help of people who are going through the same struggle to remind you that you’re not alone and that a breakthrough depression or mania is not the end of the world.

Step 3: Make a decision to turn our lives over to the care of medical science. A part of your life does get turned over to the meds and medical science, and they certainly are a higher power of sorts. You gotta take your meds every day and on schedule. So if you look at medical science as the Higher Power, then we must certainly take this step wholeheartedly. But your psychiatrist is not your God, your psychiatrist is, at best, your priest. You confess your sins to your psychiatrist, and you get communion wafers that come in many different shapes and colors. At least they don’t taste as bad as the stale communion wafers they served up at St. Bernadette’s 7:00 a.m. Mass. Unless you’re taking Risperdal syrup for some reason. Yeeee-uck! Oh, and like priests it is not right for your psychiatrist to touch you in an inappropriate manner, nor will God get angry at you if you report any bad touches. If you think turning your life over to an established religion will help, then go for it, as long as that established religion does not force you to turn your back on medical science. Yes, that means I’m excluding Scientology and Christian Science and any other that restricts you in some way from getting access to the correct medications for you. His Holiness the Dalai Lama version 14.0 said that religion is wonderful, and it really doesn’t matter which one you pick. You should free to move from one to another if the one you’re in doesn’t work for you. The Dalai Lama said it, I believe it, that settles it!

Step 4: Make a searching and fearless moral inventory of ourselves. Dude, this is the decade of the blog. Aren’t we all doing this already? Yeah, well dig a little deeper. Just how much of a jerk were you when manic? We know how much we suck when depressed, so just don’t go there, OK. We live this step in depression. In fact, if using these steps for depression then consider all the good you’ve done in the world. But when we’re euphorically manic we are just the best people on the planet, right? Right! So meditate on all the sexual betrayals, the people you treated like dirt in your manic arrogance because you were king shit, and the lives made extra sucky by ruined credit histories. I could go on and on. Oh yeah, we were blind to the pain of others because we pissed rose water and shat gold when we were manic. It’s not pretty. Do not do this when depressed. Really, deal with this step only when you are in a period of decent emotional stability. It can make some of the side effects of meds seem far less adverse. What’s a Topamax kidney stone compared to this?

Step 5: Admit to God, to ourselves and to other human beings the exact nature of wrongs. Hey, confession is good for the soul. Open up and spill, it’ll do you good. Go ahead and start with your flavor of God, work up to your therapist, and after that the anonymous support groups. Then you can start dealing with people face-to-face. Or through e-mail. They can’t punch you in the face when you tell them something in e-mail. And, like Step 4, you can blog away like mad. Write it all down and post it on a website. www.iwassuchajerkwhenmanic.com As something you did comes up, then it goes up on the site. Or you can use a site set up to apologize anonymously, based upon the famous but no longer operating Apology Line. And, of course, Catholic Churches are available worldwide. You don’t have to be Catholic to use most of them, but it really depends on the priest who is sitting in the booth.

Step 6: We’re entirely ready to have our medications remove all these defects of character! Damn straight we are. We’re ready to put up with the side effects to quit being the worst jerks on the planet. We’re willing to shell out lots of money to stop hurting the people we love, and to stop hurting ourselves. Got that? Good. Go ahead and get a spiritual or secular philosophy to reinforce this, as that really helps too. But you must get medicated first to stop being such a dillhole on a regular basis.

Step 7: We swear to $DEITY/ancestors/philosophy to remain med compliant. If we don’t stay on our meds, all of this is just a load of crap. Now some meds don’t work, or stop working, and some side effects are too much to bear, so it’s OK to stop one or more medications and switch to other medications. And for that very, very small percentage of people for whom nothing has worked, well, I’m sorry, this obviously is not the program for you. Yet. With any luck there will be something that will work for you. Not every psychological problem requires medication, but the vast majority of people in the bipolar spectrum sure as hell do. Vast majority? Yeah, I’ll admit that some cyclothymiacs could possibly get along without meds. But they are a tiny minority of the population in bipolarland, as are those who can’t tolerate any medication. Plenty of people give up after trying five or six different meds, when there are over forty, count them, forty medications that act as mood stabilizers. That’s all of the antipsychotics, all the lithium variants, a couple benzodiazepines and most of the anticonvulsants. I’m not even counting any of the antidepressants. Don’t give up so easily.

Step 8: Make a list of persons we had harmed and become willing to make amends to them all. This is the step that makes everyone hate people who are in AA. Why? Because the people in The Program do things to make amends that just make themselves feel better, and get really obnoxious and pushy about it. Or there’s an insincere “I’m sorry,” as if that’s going to make up for all the shit they’ve done, and it’s on to Step 9. Making amends is tough. You have to find something that is going to make a difference. You might not be able to do that. You may never be able to make amends with some people. That’s life, deal with it. You’re going to feel shitty about it. It sucks. That’s why God invented therapists. Maybe you can find some kind of charity that you can associate with the people you’ve wronged and can’t make up to and do some work in their names, not yours, their names. Hey, you’re the one making up for misdeeds, if you have to work under a gender reassignment, that’s your problem. There’s nothing easy about this. Try not to be another type of jerk in this category.

Step 9: Get involved with a support group and help people, just try not to fuck them up. That second part is the killer. We all make mistakes, we say or do the wrong things. Please be careful with other people, especially those in crisis. Otherwise your list in Step 8 will keep growing. But don’t freeze up and be silent and do nothing. Let others know what you’ve been through, share your experiences. Let people know what worked for you and what didn’t. Just remember these words of wisdom that should always be added to any advice you give, “Your mileage may vary. What worked for me may not work for you.” If nothing else, just letting other people know that they are not alone, that someone else has been there, that is sometimes a huge help. In the face-to-face support groups they’re always hugging each other. That seems to help when nothing else does. The Deadhead AA types never hugged each other. Maybe Jerry was against it.

Step 10: Lather, rinse, repeat. Just because you’ve gone this far, presuming you’re going through the steps one at a time, doesn’t mean you’re cured. Not by a long shot. If you’ve been keeping a mood chart, keep doing so. If you’ve been digging into your past about all those hurts, keep digging. If you’re going to therapy and exorcising demons, keep exorcising even if you think your psyche is all buff and shit. Have you really made amends to everyone? All the guilt AA lays on they lay on extra thick here. There’s no need for that. Just remember, bipolar is cunning, it’s tricky, you have to be stronger and smarter than it is, and you know how strong and smart you can be when you’re manic. Oh, and if you’ve been feeling stable for some time and think you can stop taking your meds, DON’T!!!!! That’s crazy pyramid-scheme thinking. How do you think you got stable in the first place? Obviously your meds are working. After a few years of stability, and I mean total stability with no breakthrough manias or depressions, you can consider discussing with your doctor a reduction of some of your meds or even a phasing out of one or more meds from a cocktail. At this point I’m not even sure if I’m going to do that or just resign myself to a life sentence of medications. But the odds are you’re going to have to be on something for the rest of your life. The best we can hope for is being on a low dosage of one or two meds. But I’m fully aware that remission does happen. You may be able to go off your meds at some point. But that’s after years of complete and total stability.

Step 11: Learn as much as we can about medications and therapies to make informed decisions about them and to help guide others in making informed decisions. Does this mean you need to be a junior psychopharmacologist? Of course not. But as long as you learn where to go for good information about different meds and therapies and can point other people in those directions, that’s all you need to do. Remember Step 9, just don’t mess anyone up. I’ve put together this site to help you become a better-informed consumer. Some other places to look are Remedy Find to get Consumer Reports-style ratings and comments from actual users on a variety of medications for psychiatric and non-psychiatric disorders; and our page on places to go for more information. The Needy Meds people can help if you’re really broke. If you’re not that broke but still have to pay full retail, check out buying meds from many of the fine Canadian pharmacists who advertise here. Just read up on how to select a good pharmacist. Not all meds are available to buy from the Great White North, nor are they all cheaper, but it’s worth a look. You may also find meds at even lower prices in other countries, but that just became too much of a hassle for me.

Step 12: Go out and recruit other bipolar types for this new cult so I can get rich as a guru. Make them get cash advances on what credit cards they have left and send me all their money. Paypal works.
What? That’s what this step is in the AA book, I’m just cashing in on it instead. Look, I’ve had to sell my house in California and move to Montana to crawl out from being up to eyeballs in credit card debt from a Geodon-induced mania and having to pay for all the meds I’m taking now. Oh, all right, you don’t have to send me any money. And please, leave your credit cards locked up in a safe place. If you think this can be of any help, spread the URL. But, yo! Ted Turner, if you’re reading this and it has helped you chill out, I think you can afford to send me a few bucks.

Support groups are important to make this work. Yes, your family, or whatever passes for your family in your life (roommates, coworkers, friends, fellow members of your church, etc.) are critical for your support. In fact it is good to bring some of them along with you to some of your therapy sessions. Yet often they just don’t understand what you’re going through and will expect you to either get better really fast or, worse yet, cowboy up and deal with it because “it’s all in your head.” In other words, they’ll make things worse for you. Seriously. Not intentionally, but that’s what they are doing. They don’t understand that bipolar disorder, like many mental illnesses, is very much like a broken leg of the soul. Since these people don’t see the cast and crutches, they think there is nothing really wrong with you. That’s another reason why I like fancy brain scans of bipolar disorder. People understand pictures. There, an x-ray of bipolar, just like an x-ray of a broken leg. See, it is real. Yes, the disease is in your head, but it’s not “all in your head.” Instead of a cast and crutches, you take medications. It takes some time to adapt to walking around on a cast and crutches, just as it takes time to adapt to the meds. With some badly broken legs the bones occasionally need to be re-broken and reset. Ouch!! With bipolar the first try at medications don’t always work. Some badly broken legs require surgery and the placement of metal pins that set off metal detectors and require explanations for the rest of your life. Bipolar will probably require life-long medications and similar life-long explanations.

You can help your family understand. Doctors and therapists can help your family understand. Here is one of many websites that will help you explain it to the people in your life. But even if you get everyone in your life accepting that you’re bipolar and it’s going to take time to stabilize, if they haven’t gone through it themselves they can’t give you all of the support you need. You need to interact with people who have gone through this before, who are going through it right now. That’s all there is to it.

You are not alone. There are others who feel fucked-up in very similar ways, maybe even exactly the same utterly fucked-up way. Right this very instant. Or they have in their lives. Or, sadly enough, somebody will in the near future.

I personally think the online support groups are superior to the face-to-face support groups, but I’m mildly autistic and had a truly messed up childhood so I don’t play well with others. The advantages to the online groups are:

They are always there (there’s not a guarantee that someone else is in a chatroom, which I despise anyway, but the fora are always there, so you can read and type and read and type so it’s like there is someone always there).

It’s much more difficult for someone to follow you home. It’s not impossible, just a lot harder.

By the same token it’s much more anonymous. Not that I’m Mr. Anonymity, because I’m all about breaking the goddamn stigma, but for all of you who wish to remain anonymous, it’s easier to remain anonymous when no one has to see your face. Again, a determined person can still break the veil of anonymity, but it’s just harder to do.

No one can punch you in the face after you say something stupid and hurtful.

Moderators can make your stupid and hurtful things disappear. Dangerous words and phrases can be altered to be less dangerous or warning signs can be put up.

It’s easier to ignore particular people through the wonders of filtering technology.

No driving to across town or to another town.

No perfume assaults.

Less intense psychodrama. There’s plenty of psychodrama, you just don’t get all the full effect.

10. Access to the vast amounts of information referred to is just a mouse click away.

The advantages to the face-to-face groups are:

The warmth and fuzziness of human contact, if you’re into that sort of thing.

Body language and tone of voice play a huge part of human communication, for those of you who pick up on them.

Hugging. Again, if you’re into that sort of thing.

Dinner.

Group activities.

More cathartic experiences, both in quantity and quality.

Once you ban someone, they can’t come back because you know who they are. You ban someone from an online group, they just get another e-mail address and they’re back to stir up shit.

Med exchanges. Hey, as long as you have a prescription for the medication, it’s perfectly legal to receive free medications from someone. As for giving away meds you no longer use to someone else, that could get you in trouble. But in these fucked up times what else are we going to do?

Better chances for dating. Look, it’s still pretty damn lonely for a lot of us.

10. Endless amounts of free coffee.

So if you’ve decided to at least check out a support group or two, where do you start? Don’t worry, I’ve put together an entire page of links to diverse support groups.

You can do it. You can walk away from mania, with the help of medications, a change in your lifestyle, the help of your doctors and the help of others who have been through it. Give back that help, it will help you in return.

And where am I? I am so stuck with Steps 5 and 8. Making amends and all. It is tough. I’ve been very, very bad. I overcompensate with Steps 9 and 11 instead. I’ll take the Topamax kidney stones over trying to put my past misdeeds to right, if such is even possible.

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