My reflections take me back to our little bungalow on the hill. At the time we were renting a light filled house in San Diego with a huge deck, beautiful views of the mountains, surrounded by towering king palm trees, and overlooking our almost private pool. We were living in a rural area that was close to expansive farms and greenhouses with every type of rare and exotic plant you can imagine, including the beautiful and resilient succulent. Now, it is important to note that both my husband and I are east coasters, so the succulent, a southern California desert plant, was rare and intriguing to us. Thinking on it now, the succulent feels like a parallel to our marriage at the time: requiring little water or care to survive, resilient and exotic.  Just leave it in the sun and it would flourish, even flowering these rare, beautiful, and unexpected blooms. My husband took this fascination to a whole new level.

Now I know the typical image of the opiate user is one who is nodding out, sluggish, and lethargic. My husband has never been this way, and it took me a long time to see this. His high looks just that: happy, elated, rapid speech, disorganized thoughts, mania, delusions of grandeur, and sleeplessness. Nights and nights of sleeplessness. So this takes me back to the night of succulents. I woke up on a workday morning to find that my husband was no longer in bed with me, this was not surprising. He was in the living room, his eyes wild, him looking foreign to me, and he excitedly told me he “has something to show me.” Rubbing the sleep from my eyes and feeling pre-coffee blah, I followed him to the deck so he could unveil this surprise. There I found to my horror, our 500 square foot deck filled with hundreds and hundreds of succulents. He had been up all night “acquiring” (stealing) them.

Around this time, my husband began therapy working with a psychologist and psychiatrist. It was then that he was first diagnosed with bipolar disorder, he was 34 years old. Looking back, I think there were a variety of factors leading to his diagnosis, his behavior of course and a family history remarkable for the disorder on his father’s side as well as his sister. The mania would come followed by  days of dark deep depression. Now, I will get into this in a moment, but diagnosing my husband while he was in full blown using mode had its implications: how could we know what behaviors were a manifestation of the drug use as opposed to that of the bipolar?   I know that concomitant addiction and mental health disorders are not uncommon. In this case the addiction and psychiatric disorder are two distinct diagnoses.  This is what I have learned about dual diagnosis:

  • The individual may not know they have an underlying mental health condition
  • The individual may use drugs or alcohol to self-medicate in attempt to alleviate some of the painful symptoms of his or her disorder
  • Stigma and lack of resources may make it difficult for an individual to seek mental health treatment thus leading to self-medication and addiction
  • Common diagnoses include anxiety and depression

So back to those implications, fast forward to a few months ago when my husband was released from a week’s inpatient stay in a dual diagnosis unit. During his stay he had detoxed from all opiates, even suboxone. He said to me during the car ride home: “I don’t think I have bipolar, I think I have anxiety and depression”. He further divulged that his grandmother used to lock herself in her room for weeks at a time suffering from depression (she was never an addict).  I agreed: the mania was his high and the depression was his detox. We never saw this when he was clean. Of course, I told him he should talk to a professional about this and see what their clinical impressions were during a time of sobriety. That hasn’t happened yet, despite me urging him to talk to his physician about a referral and to seek treatment.  The fear and worry seep in. How much longer can he maintain this stint of sobriety (if in fact he is clean) without appropriate treatment for this anxiety and depression. How much longer until he goes back to the dope, the only treatment he has ever really known? I want to remind him: you are not that resilient succulent that can go without water or care, flowering in harsh and severe conditions. I want him to hear my loving words: no, instead you are a beautiful rose, requiring the utmost in care, a tender touch, sunlight, water, and nutrients. I want him to believe he deserves that the way I do.


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