Robin Williams: Depression, Bipolar Disorder, Substance abuse And Suicide

robin-williams7878It’s hard for many people to understand how someone can be “successful”, and “wealthy” and still be miserable and end up committing suicide, but mental illness and substance abuse doesn’t care about socio-economic status.

There are countless examples of wealthy and famous celebrities who have taken their lives in the face of mental illness and/or addiction. 

Still, many are shocked that someone so funny and loved as Robin Williams, age 63, who’s been battling bipolar disorder, severe depression, drug abuse and alcoholism for a large part of his life, would end up taking his own life. 

For anyone who has ever felt the pain of severe depression knows that once it has a grip on them, it’s almost like being covered in darkness where they can’t see past their failures, no matter how successful they are.

The only thing that they see, hear and think about are their missed opportunities, mistakes and what seems like the bleakness of the future. It doesn’t matter if they are happily married, have accomplished many goals, all they see are their failures. They forget all of their successes and things they should be proud of and just become consumed with feelings of worthlessness, shame and guilt.

When in a deep depression, suicidal thoughts may creep in and become overwhelming to the point where the person feels like they are a burden to the world, especially those close to them. They feel like their spouses, children and friends would be better off without them. Their view of reality becomes severely distorted.

In Robin Williams case, he was married, had children, had a long successful career, was loved by millions, yet he battled addiction, bipolar disorder and depression. At some point in the midst of his depression, the thoughts of being worthless and a burden became overwhelming. 

It also speaks to the point that depression and suicide doesn’t go away at a certain point of wealthiness or happiness. It’s a disease.

Robin Williams is no different than anyone else who suffers from a severe mental illness. About 90% of people who commit suicide have an undiagnosed, untreated or undertreated mental illness. 

Robin Williams was also in the demographic of those highly at risk of suicide which are white, middle aged men with health problems. Robin Williams had been suffering from a heart condition and it’s possible that the thought of losing control of his life, his quality of life or losing his life in general to a physical illness, increased his risk of suicide. 

More than 38,000 Americans commit suicide each year and while depression can last a life time, suicidal thoughts are usually temporary and the act of suicide itself is often impulsive. If we can deter someone from committing suicide they usually will move on from the desire to kill themselves even though the depression continues. 

According to the American Association of Suicidology:

  • 39,518 people died by suicide in the U.S. (2011)
  • 108.3 per day
  • 1 person every 13.3 minutes
  • 3.6 male deaths for each female death by suicide

Comparison to other highly publicized causes of death per year:

  • Homicide 16,238
  • Prostate Cancer 32,050
  • Motor Vehicle Accidents 35,303
  • Suicide 39,518
  • Breast Cancer 39,520

By age:

  • Middle age (45-64 years): 18.6 per 100,000,
  • Elderly: 15.3 per 100,000

*Teens (15-24) is 11 per 100,000*

*The rate for middle aged has been increasing and surpassed the rate for elderly a few years ago*

If you are anyone you know is suffering from suicidal thoughts, the national suicide prevention lifeline can be reached at 1-800-273-8255 or http://www.suicidepreventionlifeline.org

A Brief Look At Prescription Drug Use In Teenagers

prescription-drugs-stock-photo-istock (1)I’ve spent a lot of time speaking with parents about teen substance abuse and still find it amazing that most parents are worried more about their child’s friends or a drug dealer exposing them to hard drugs and are still ignorant to the potential for drug abuse the lies right in their own homes.

They still worry about their kids being exposed to alcohol and marijuana, which they should be, but they aren’t worried about what is already in their medicine cabinets, especially prescription painkillers.

With this generation of teenagers, the use of prescription painkiller abuse is up forty percent compared to previous generations according to the University of Colorado Denver researchers, making prescription drug abuse the second most common type of illegal drug use after marijuana.

Teenagers today are turning to Vicodin, Oxycontin and Valium found right at home with prescriptions filled by their parents or other relatives. Many kids often then take these painkillers to school and share/sell them to their peers.

A few schools in my area have a big enough problem with prescription drug use that they do regular searches complete with drug sniffing dogs and all. I’ve worked with a handful of teens addicted to Xanax and Oxycontin that they get right from their own homes.

Often they don’t even know the strength of the drug (or how to read the strength), making the potential for accidentally overdosing extremely high. To top it off, teens often mix taking pills with alcohol which can easily lead to a medical emergency such as respiratory arrest and even death.

According to the Los Angeles Times, 2011, “Drugs exceeded motor vehicle accidents as a cause of death in 2009, killing at least 37,485 people nationwide, according to preliminary data from the U.S. Centers for Disease Control and Prevention.”

Also, some scientist believe that the teenage brain, which is still developing until the early 20’s, is especially susceptible to chemicals which can cause changes in the brain and lead to a lifelong battle with addiction.

Why The Epidemic?

Prescription drugs are more available today than ever, which explains the explosion of prescription drug use in teens.  There are so many prescription pills around the house that it is easy for teens to procure them from family members and friends.

We are not talking about pill mills here where adults go to get their fix to prescription medication from shady doctors, but we are talking about legit doctors who may be over-prescribing medications to people who may or may not need the stronger, more addicting medications.

Some parents may also like the “buzz” they get from their prescription pills although they may not abuse them the way their teens are likely to.

Many teens also think that prescription drugs are harmless because they are prescribed by a doctor, their parents take them and their legal. This false since of safety is a dangerous one as hospital emergency rooms around the country are seeing thousands of teens each year due to prescription drug overdose.

What Can Parents Do?

Parents should talk to their teens about prescription drugs, just as they should about other drugs and alcohol. They should also look for signs of prescription drug use such as sleepiness, weight loss, slurred speech and decrease in academic performance.

Parents who have prescription pills should keep them locked up so not to tempt their teens. Treat them as if they were a loaded gun, locked and hidden out of sight.

Parents should also talk openly with their teens about family history of drug abuse just as they would about a family history of other medical illnesses.

It’s amazing how many parents never talk about the long history of addiction, alcoholism or even mental illness in their families, but are surprised when their child finds themselves using and unable to stop using drugs or alcohol.

It’s only fair that a teen know about their vulnerability to addiction so that hopefully that will be an extra motivation to stay away from potentially life changing behaviors.

Mindy McCready: Addiction, Mental Illness And Suicide

1358256839_mindy-mccready-articleSuicide is such a tragic occurrence in life, something that always surprises me a little, even when it’s expected, such as in the case of Chris Domer.

Even more shocking are the instances when it’s not expected, even if the person has had a troubling past, such as Mindy McCready.

Mindy McCready was a 37 year old country music star who apparently committed suicide this past Sunday afternoon by shooting herself in the head on her front porch. Besides being a country music star, more importantly, McCready was the mother of two boys, including a ten month old infant.

It’s hard to imagine the stress/circumstances that would cause a mother of two to want to take her own life, so I thought it would be a good idea to examine some of the stressors McCready was under.

Recently, her fiance and the father of her ten month old infant, record producer David Wilson died of an apparent suicide. This tragedy in itself could have been enough to push McCready into a suicidal state. Here is the father of her infant child, now dead, someone she had planned to spend the rest of her life with, and now he’s abandoned her.

On top of that, whenever someone close to someone commits suicide (and often they don’t even have to be that close personally), it makes it easier for that person to think about and even commit suicide themselves if they are already in a fragile state. That’s why having a family member who has committed suicide makes a person more at risk for committing suicide and why communities and schools often experience clusters of suicide after someone in that community or school has killed themselves. Perhaps the death of her infant’s baby’s father made it easier for McCready to end her own life.

On top of that traumatic experience, McCready also suffered from addiction and mental illness, both of which increases a persons likelihood of attempting suicide.

McCready had two previous suicide attempts in 2005, including attempting to overdose on drugs and alcohol. She was found unconscious in her hotel room and hospitalized. Then later that September while pregnant with her first son, she attempted suicide again by overdosing on anti-depressants. In 2008 McCready was also treated for an apparent suicide attempt after slashing her wrists. She was hospitalized at least once more after an overdose, or what may have been a bad reaction to some Darvocet apparently given to her by her mother.

Her battle with addiction and mental illness was often public. She appeared on Celebrity Rehab with Dr. Drew Pinsky and on The View. She spoke with Dr. Drew about the stigma she felt from the media and her fans about being in rehab, a topic he discussed on CNN after her suicide:

“Her biggest fear was the stigma of doing so and what people would think if she, God forbid, took care of herself. And this to me is the most distressing part of this story. She is a lovely woman, we have lost her, and it didn’t have to go down like this.”

McCready was also dealing with an ongoing custody battle that was often nasty and very public. Her ex-husband who is her first son’s father, Billy McKnight, wanted primary custody of their son and filed motions in court to have McCready submit to drug and alcohol testing and also undergo a psychological evaluation.

Despite her struggles with addiction, mental illness and an often rocky personal life, McCready still tried to remain positive. On her fan page in January 2012 she wrote:

“I haven’t had a hit in almost a decade. I’ve spent my fortune, tarnished my public view and made myself the brunt of punch line after punch line. I’ve been beaten, sued, robbed, arrested, jailed, and evicted. But I’m still here. With a handful of people that I know and trust, a revived determination, and both middle fingers up in the air, I’m ready. I’ve been here before. I’m a fighter. I’m down, but I’ll never be out.”

Perhaps the death of her infant’s father, a man she called (after his dead), her soulmate and life partner, was the final straw that broke the fighter in her. They both apparently killed themselves by shooting themselves in the head.

It could have been her addiction. After all, she had left treatment for substance abuse early and was reluctant to re-enter treatment due to the stigma she had faced in the media and with fans.

Chances are, it was a combination of everything: addiction, mental illness, dealing with the recent death of her fiance, a custody battle and having an overall bleak outlook on her future.

Suicide is a permanent solution to a usually temporary problem.

It hurts when we lose anyone to suicide and addiction and it’s sad that we have lost yet another bright star. Like Dr. Drew said, it didn’t have to go down like this.

My Day Working At A Women’s Residential (Addictions) Facility: Observations And Thoughts

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Yesterday I was blessed to be able to go and work with a group of women in a women’s residential facility. All of these women varied in age from barely twenty to the elderly, yet they all battle some form of substance abuse.

None of them looked like “typical addicts” and they were all extraordinary women.

Many of them were mothers or wives and of course daughters who had lost nearly everything due to their alcohol, cocaine, crack-cocaine, prescription pills, meth or heroin addiction.

One older lady had battled addiction for most of her life and at one point became homeless before finally making up her mind to try to get sober and clean. She has seven months sobriety.

Another woman who looked like she couldn’t have been a day over twenty, but had a five year old child, had been clean for four years before an old dealer of hers found her on Facebook and seduced her into using again.

And another older female had been pretty much a functioning alcoholic for the past five years and then one night out of the blue had an alcohol related gran mal seizure that landed her in the hospital for five days and she was court-ordered to rehab from there.

A lot of the women had tragic stories, including a very young girl who I don’t think was even twenty and was in rehab for the first time after being court ordered into treatment.

She was adopted, her birth mother was a drug addicted, her birth father was in prison and when her adopted father died two years ago she started using any drug she could get her hands on to numb the pain she felt.

Working with these women yesterday in group and individual settings I took a lot away from not only what it meant to become and remain substance free, but also what it meant to accomplish any major goal.

Having a good support system of course is important.

The women who had a supportive family, a supportive group of people such as Alcoholics or Narcotics Anonymous, supportive healthy friendships, supportive professionals or a supportive sponsor all seemed to be doing better than those who did not.

Having a belief in and a relationship with a Higher Power also seemed to help.

Not that there weren’t many women there who weren’t religious, but it was obvious that those who had some type of relationship with God, the universe, or whatever, seemed to be doing better in recovery compared to does who didn’t.

Also, those who were honest with themselves and in touch with reality seemed to be doing better than those who seemed to be a bit oblivious to reality.

The one thing that bothered me most about a lot of the women in the facility were that a lot of them were lying to themselves as we all do from time to time, especially when trying to stop a bad habit.

Many of the women still had “addict behaviors” not only in the fact that they were lying to themselves, but they were also lying and being sneaky to others.

For instance, this was a smoke-free facility where these women are prohibited from smoking, yet a number of the women sneak out and smoke.

That may seem relatively harmless in comparison to their bigger addictions, but that type of sneaky, dishonest behavior sets the stage for future relapse.

Relapse is not something that usually just happens, but develops overtime in the way a person thinks, feels, and acts.

A sober, clean person may start feeling agitated, lying, sneaking off to do things they know they shouldn’t, etc., days, weeks or months before actually relapsing.

They start lying to themselves, saying things like, “I can just have one drink” or “I can just take one hit and walk away, I know how to control it now”.

Before you know it, they are back in the thick of their addiction, driving under the influence to get more alcohol or selling whatever they can get their hands on to get more drugs.

Most of these women displayed some of those signs of a future relapse, from sneaking off to smoke, to being angry and irritable, to the woman who had the seizure asking me:

“How much do you think I’ll have to drink for that to happen to me again, because it scared the hell out of me. I don’t want to drink any more, but I just want to know if I have one drink, or two drinks, how many would it take before that happened again?”

Although she’s telling me she doesn’t want to drink again, she is lying to herself. It is obvious that in her conscious or unconscious mind, she is trying to figure out if she can get away with drinking “just a little”, but she is an alcoholic, and knows that there is no drinking “just a little” for her.

The women sneaking off to smoke, will be the same women sneaking off to drink or get high once they are out of rehab. That is “addict behavior” at it’s best.

Just like in trying to quite anything from smoking to losing weight, people generally relapse and it takes a few tries before they get it right. Relapse at some point is usually expected which is why there is often a focus on relapse prevention.

One of the biggest things to know about relapse is that if you mess up, if you have a drink, or a hit, or a donut, it doesn’t mean you just give up and give in. You can still back away at that point and start over before the addiction truly regains a hold of you.

All the women in this facility are at different points in their recovery and no doubt, for many of them, this will not be their last time in treatment, but hopefully one day they will get it right.

Teens, Marijuana and Nutella

The other day during a group therapy session, one of my teenage clients told me she had been tempted to use marijuana for the very first time.

I questioned her about why she was tempted to smoke marijuana and she informed me that she wasn’t going to smoke it, she was going to eat it. She had been offered some marijuana sprinkled on a cracker covered with Nutella.

This was the first time I had ever heard of teens eating marijuana on a cracker with Nutella, but that’s not the point of this post. Most teens believe marijuana is harmless, and I spend a lot of my time trying to convince them that it’s not.

From my experience, working in the field of substance abuse, I tell them that in a lot of cases, marijuana zaps motivation. Teens I work with who use marijuana usually start failing classes, missing school and eventually dropping out or getting kicked out of school.

Also, there is growing evidence supporting a correlation between marijuana use and schizophrenia.

Marijuana doesn’t cause schizophrenia, but it does seem to activate schizophrenia and other mental illnesses in individuals with a predisposition to mental illnesses, especially schizophrenia.

In the book The Center Cannot Hold: My Journey Through Madness by Elyn Saks she shares intimately about her battle with schizophrenia that all started after her first experience with marijuana.

She thought the hallucinations and thoughts that came and stayed for days were all normal and so she didn’t tell her parents out of fear of being punished for having smoked marijuana.

I’ve worked with a handful of schizophrenic patients who had their first schizophrenic experience after smoking marijuana and initially thought that their experience was typical until much later when the hallucinations and delusions didn’t go away for days, weeks or never.

These people all had a predisposition to schizophrenia which seemed to be activated after they started smoking marijuana. If they hadn’t started smoking marijuana, that doesn’t mean some other life event wouldn’t have activated the gene, but who knows.

Teens argue with me that marijuana is not addicting, but it is. Marijuana is psychologically addicting, why else do people who are regular marijuana users do the some of the same things people addicted to harder drugs do when they are addicted?

Some of the signs of being addicted to anything is when that thing starts to interfere with and effect your life negatively.

Teens I’ve worked with who claim not to be addicted to marijuana have:

  • Missed numerous days of school to stay home and smoke mariuana
  • Come to school high and thus got expelled
  • Got caught smoking marijuana at school and thus got expelled
  • Got pulled over while driving and smoking marijuana
  • Have violated their probation for smoking marijuana after being on probation for marijuana in the first place
  • Have lost jobs for smoking marijuana on their lunch break
  • Have stolen from family and friends to support their marijuana use
  • Have damaged relationships with family and friends over their marijuana use
  • Can’t get jobs because they can’t refrain from marijuana long enough to pass a drug test

These are all signs of addiction. These are all the same things people with cocaine, crack, heroin, alcohol and crystal meth addictions do. Yet these teens still think they aren’t and can’t be addicted to marijuana.

Then they argue that marijuana should just be legal. I’m not going to argue that point here, but even if marijuana was legal it still wouldn’t be available to people under 18 and most likely, not to people under 21.

Even then, employers would probably put in place rules where you couldn’t either test positive for marijuana or at the least, not come to work high. Same goes for places of higher education, the department of motor vehicles and such.

So while teens think legalizing marijuana will mean a free pass to smoke at will, it actuality won’t.

Marijuana use also leads to a higher risk of experimenting with other drugs and I’ve seen enough teens using hard drugs that started with marijuana to know that this is indeed true.

No teen I know who smokes weed can imagine smoking crack, but most people I know who smoke crack started off by smoking weed and didn’t see the day coming when they would be smoking crack or shooting heroin.

I’m not saying marijuana is all bad or trying to bash people who use it, but I do know one think for certain, and that’s that no teenager should be smoking or experimenting with marijuana, especially as their brains are still developing and they have enough trouble making good decision when they aren’t influenced by substances as it is.