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Double trouble: Mental illness and alcoholism

It was a rude awakening in the wee hours – forceful drubbing on our kitchen door, all the more audible as the bedroom was directly above.

Crossing the kitchen, I recognized a state police cruiser idling in the driveway, lights flashing. I wasn’t on call, so my phone had been off. As I opened the door, the officer said he needed me to come to our small clinic to evaluate a man for admission to the state mental hospital. My clinic partner already was there as two physicians were required to obtain an admission.

It turned out that I knew the man, who was in his late 30s, married with several kids and sole owner of a welding shop in a nearby town. He had done some welding for me, small stuff, and, true to his reputation, it was quality work. His two-bay shop was about 30-by-40 feet, with an apartment on the rear. I had gleaned that his morning work was superior to that done later; his “friends” often jump-started him with a few beers as noon approached. It was no small wonder that his driving privileges had long been revoked.

He had stripped a derelict car and modified it so as to be horse-drawn. Episodically cruising through the town and past a state police barracks, he blasted a horn, taunted the officers and flipped them off. On the night above, the police responded to a “domestic disturbance.” Approaching the scene, they were greeted by a shotgun blast – it got their attention.

Ultimately, his choices were either jail or the state hospital, thus my post-midnight ride to the clinic. Later, claiming that his had been a voluntary admission, he defied all; he walked. He called me and my partner: “I’m going to get you.” Police were notified, our doors locked and a firearm kept handy – never before, never since.

The concluding episode came months later. Ordering his family out of the apartment, he also summoned the police and a cruiser responded. He cracked open his acetylene and oxygen tanks and must have struck a spark. As the officer pulled up, he saw the entire building rise 2 feet before it came apart. Had he arrived seconds earlier, he might have been outside the cruiser. A large spruce 30 feet away burned completely; a nearby house survived thanks to the volunteer fire department.

The horse-drawn car, the shotgun blast, the threats and the explosion smack of the grandiose – and mania. He was not the “usual” alcoholic; his behavior suggests mental illness, specifically bipolar disorder, formerly manic depression, as well as alcoholism.

This “dual diagnosis” is more common in young males and the risk of alcoholism (or other substance abuse) is higher for bipolar disorder than for any other psychiatric condition – slightly more than 50 percent. It is a living hell, and suicide is not infrequent. Recovery from bipolar disorder and concomitant substance abuse are doubly difficult.

The police gave him a choice, my partner and I enabled that choice, but he missed his opportunity for treatment, recovery and, ultimately, survival. Fortunately, he took no one with him.

www.alanfraserhouston.com. Dr. Fraser Houston is a retired emergency room physician who worked at area hospitals after moving to Southwest Colorado from New Hampshire in 1990.



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