For Taryn Temmer, life looked pretty decent on the outside. Always hardworking and motivated, she was an accomplished lawyer and had run a successful practice for 17 years. 

Since she was about 14 years old though, Temmer self-medicated with marijuana only she didn’t know what she was self-medicating from until she entered treatment in 1997. 

“When I went to treatment the first time, they diagnosed me with bipolar disorder,” she says. 

For the first time, Temmer had an answer to the mania she’d been dealing with since she was a teenager or younger. Though she only stayed in treatment for a week at that time, she had a piece to her personal puzzle that didn’t exist before. 

Though getting sober can be difficult no matter what, dealing with a dual diagnosis like bipolar disorder and substance use disorder (SUD) can make things all the more complicated. 

For starters, says Dr. Roger Bayog, a psychiatrist with Spectrum Health Systems in Worchester, MA, is that bipolar disorder and substance use disorder have symptoms that mirror one another, making it difficult to diagnose. 

“Many symptoms like mania, depression, and erratic behavior can apply to many diagnoses, making it difficult to get an accurate diagnosis for this particular combination,” he says. “It’s very important for the clinician to be as precise as possible about the diagnosis.”

“Many symptoms like mania, depression, and erratic behavior can apply to many diagnoses, making it difficult to get an accurate diagnosis for this particular combination.”

For Temmer, a diagnosis for bipolar disorder came first, but she wasn’t ready to get sober at that time, she said. Still, she continued to see her doctors. Though she was gaining information on how to manage her mental illness, her addiction to crack cocaine had to be quelled first.

“I can’t tell you if I was taking care of my mental illness or not back then. Probably not. Using came first,” she says. 

During that time, her license to practice law was suspended four separate times. It wasn’t until 2004 that she entered treatment for SUD and stayed. It was then that she found ways to manage both her bipolar disorder and her substance abuse. 

In-patient treatment, says Dr. Bayog, is necessary most of the time for someone with this particular dual diagnosis. In a residential treatment program, he said, patients have the much-needed support they need.

“They have the support of the clinicians within the program on a daily basis and they have assistance in how to manage the mental illness part,” he says. “One of the essential components in this scenario is that staff will assist the patient in making sure they take their meds as scheduled throughout the day.”

Medication, says Dr. Bayog, is essential to maintaining sobriety and a mental equilibrium for someone with bipolar disorder. 

“The complexity of the problem is in these details,” he says. “And because bipolar and substance use disorder symptoms can vary widely from one patient to the next, the proper dosage and frequency of medication is instrumental in treatment.”

“Because bipolar and substance use disorder symptoms can vary widely from one patient to the next, the proper dosage and frequency of medication is instrumental in treatment.”

But, says Dr. Lawrence Weinstein, chief medical officer of the American Addictions Centers, medication is only part of the solution.

“Treatment for a patient with bipolar disorder and an AUD/SUD involves both psychosocial and pharmacological therapy,” he says. “While the use of medication is important, equally as important are the behavioral therapies used. Cognitive behavioral therapy (CBT) is one of the most effective psychosocial treatments for affective disorders, like bipolar disorder, and it has also been efficient in treating substance use disorder. A combination of these two methodologies has shown great efficacy in treating co-occurring bipolar and alcohol/substance use disorder.”

Even if someone follows all the necessary protocol though, for this particular dual diagnosis, relapse is common, Dr. Weinstein says.

“The unpredictability of bipolar disorder lends itself to the unpredictability of an alcohol or substance use disorder because both conditions have a high risk of relapse.”

Drug and alcohol use can worsen the symptoms of bipolar disorder, making it more difficult over time, especially if a person does not have access to proper medical care. 

“It takes a team of people to provide the support, medication management, and treatment that will help patients manage all of the symptoms of bipolar and maintain sobriety as well,” says Dr. Bayog. “We emphasize the importance of a doctor or nurse practitioner, a therapist or clinician to help them manage and maintain their recovery, and of course, if they’re able to work, that will help them become self-sustaining.”

Bayog also says that having a stable and safe home is imperative to maintaining sobriety and mental stability for someone with bipolar disorder. 

For Temmer, relapse is a part of her recovery story. Between her first time in treatment in 1997 and the last in 2004, Temmer relapsed several times, but she kept trying, and she’s since been able to maintain long-term sobriety. 

“The bottom line for me was that I had to make my mind up,” she says.  “I stick close to my therapist and my sponsor and my recovery program, and I just decided I’m not going to use no matter what.”

Even with long-term sobriety, she says, managing her bipolar disorder can be difficult. “I still struggle with mania and depression,” she says. “I’m more on the manic side of the spectrum.”

Temmer says her beloved dog recently passed away, and it threw her into a manic episode.

“Instead of smoking crack, I started buying shoes,” she says. For the last few years, she’s been struggling with a shopping addiction, but since she’s sober, Temmer says, she has the power to work through the shopping. 

Today, Temmer is a licensed master’s addiction counselor (LMAC) and is certified in trauma care. She uses her experience with dual diagnosis to help others struggling with similar issues. As someone who deals with both, she has a unique perspective and understands what others might not, and she’s found fulfillment in her work.

For those suffering from bipolar and substance/alcohol use disorder, she has some encouraging words: “Staying sober is possible. I’ve been sober 16 years. For me, it just comes down to taking my meds, seeing my psychiatrist, talking about my feelings, being open-minded, and staying vigilant in my recovery program.”