Gabyunbound, what an absolutely incredibly important thread and a topic we do not discuss nearly enough, in my opinion.

In 2007, folks at Columbia published a paper showing that bp diagnoses in kids had increased more than 40-fold since the early 2000s. Then, in 2013, Mark Zimmerman published a "landmark" piece claiming that in adults, around 50% of bipolar diagnoses were in error. People absolutely freaked. Understandably. Virtually all of the "overdiagnosed" not apparently bipolar people were so overdiagnosed, Zimmerman claimed, due to coexisitng substance issues and their related symptoms.

The bottom line of Zimmerman's work and some others like it that followed is that their method for diagnosing bipolar disorder relied completely on following the DSM-V to the letter. Many, many US psychiatrists, and psychologists, for that matter, do not, in fact and in practice, make the diagnosis in this fashion, still today. One of the stated requriements of DSM-V-based bipolar diagnosis is that substances must be completely eliminated from the picture in order for a bipolar diagnosis to be coreectly made. That is a firm DSM-V requirement.

In the real world and on planet earth, where actual patients with actual lives live, this is often quite hard to accomplish. Patients sometimes do not come clean about meth use, say, as they are ashamed or firghtened of the police. Some people simply have a very hard time stopping drinking, as BD stated, while they are still bipolar-symptomatic. I was one of these. So, if we waited for every patient with a possible bp diagnosis to be totally sober and clean for 6 months, many, many patients would never be able to do that. That is just reality.

So, in the real world, strict reliance on the DSM-V is just not even possible for many folks. They can't do it. So, what are we to do? Jut not treat them, even though we are almost sure they have it, just because they do not meet full and official DSM criteria? That is moronic, unthoughtful, and inhumane, in my view. And totally impractical, as I say.

So, having reviewed the entire world literature on this as a former medical researcher with bp 1 and addcition, what I can tell you is that I and many experts believe as smart as Mark Zimmerman clearly is, that that paper simply is not accurate. It never was. The DSM-V simply does not account for what it is actually like for tons of folks who live with bipolar disorder to try to live in the actual world. That is just a fact. Not bashing, just being real.

I was initally dignossed with MDD and addiciton in 99. Finally had a huge manic and psychotic episode in 2005 and was able to get accurately diagnosed. In retrospect, all my addiction issues have been closely confined to periods when I was bipolar-symptomatic. Once those symptoms were treated, addiction vanished. Poof! A total and complete non-issue for me. My primary issue was never addiciton. It was untreated and poorly managed bipolar 1. I believe, like BirdDancer, there are tons and tons of patients in this situation. It does not mean they do not have bipolar diosrder. That is, in my opinion, a thinking and judgment error.

All of this obviously just my own personal opinion and nothing more.

If you are someone you love has been in this situation, I do strongly advise doing a very thorough and cautious life chart. It can shed light on this. You can google it and see some pictures of what one looks like.

Love and hugs!!!!!!!!!!!11