Impulsive behaviors, such as out-of-control spending, reckless sexual behavior, and serious missteps at home and at work while hypomanic or manic, can destroy credit, create financial ruin, leave one with a host of sexually transmitted diseases (hepatitis, syphilis, gonorrhea, HIV/AIDS, herpes, etc.), destroy relationships, and ruin careers. People who’ve gone through one or more manic or hypomanic episodes can typically tell you what their risk behaviors will be; it’s often a triad of alcohol/drugs, sex, and spending.
Clearly alcohol and drugs greatly increase the ability to act impulsively. So at the first sign of increased consumption, it’s going to be vitally important to get into, or back into, substance abuse treatment. If you’ve been an AA member in the past and that’s fallen by the wayside, start getting to regular meetings. Be honest with your treatment team/therapist and family/spouse about your consumption. This way they’ll be able to help you track whether things are calming down or accelerating. If the former, well done! If the latter, it will be important to step up the treatment possibly with either an inpatient or outpatient dual-diagnosis program.
Increased and out-of-character sexual behavior is common in mania and hypomania. With drugs and alcohol often clouding the picture, it’s easy for people to make serious mistakes in the heat of the moment. Clearly, ‘just saying no’ may not work, and so, while not foolproof by any means, knowing and sticking to safe-sex practices can be a life saver, latex condoms are a must, and if you use personal lubricant with them, it should be water based. If the manner of sexual activity can be contained to things that are less likely to transmit potentially fatal diseases (such as oral sex versus vaginal or anal) that will also diminish the overall level of risk. Additionally, birth control is strongly advised for women, not just for this reason, but also to protect against early exposure of a fetus to potentially damaging medications.
For spending problems, which can drain bank accounts and max out credit cards, having a good predetermined plan can save someone from years of digging out of a financial mess. With the easy ability to spend fast and furious over the Internet, figuring out a way to prevent that behavior will also need to be addressed. Some people with bipolar disorder who don’t want to eliminate their love of shopping have found that limiting their access to credit cards and ATM machines and taking a predetermined amount of cash to flea markets, garage sales, and thrift shops keeps shopping satisfying and fun without leaving them with guilt and debt.
Additionally, if someone does go into a serious mood episode, handling the day-to-day finances can create an additional stress, so thinking through whom you’d like to pay the bills, the mortgage, etc., for you makes good sense. Getting this in writing can be especially useful.
Strategies that might help include:
• Have low limits on credit cards or no credit cards
• Don’t have an ATM card or have someone else take responsibility for it at the first sign of becoming hypomanic
• Arrange direct deposit of paychecks; never get paid in cash
• Give someone the legal authority to pay your bills if you are hospitalized. Additionally, having direct payment of regular monthly bills can ensure that the car payment, electric, phone, and rent and/or mortgage are handled.