One of the most confusing aspects of addiction is that while the addict may commit unspeakable acts when under the influence, he is most visibly sick between uses. This gets for worse as the addiction progresses. It probably accounts for the fact that the reported incidence for most crimes occurring while the perpetrator is under the influence is only in the 40-50% range. Milam and Ketcham point out, "When the alcoholic stops drinking, all hell breaks loose. Blood vessels constrict, cutting down on the flow of blood and oxygen to the cells. The blood glucose level drops sharply and remains unstable. The brain amines, serotonin and norepinephrine, decrease dramatically. Hormones, enzymes, and body fluid levels fluctuate erratically. The body's cells are malnourished and become toxic from long exposure to large doses of alcohol and acetaldehyde," and because he stopped drinking, no longer has alcohol as his "major source of energy and stimulation and as an antidote for the ever-present toxicity."
"These chaotic events cause fundamental disruptions in the brain's chemical and electrical activity. The resulting pandemonium creates numerous psychological and physiological problems for the alcoholic, including profound mental confusion, memory defects...paranoia, violent or fearful behavior...." No wonder we can't link substance addiction to criminal activity. Too often, the crime occurs when the addict is not under the influence or is coming down, when suffering is at its worst. In many instances, by the time of the arrest the BAC has declined to seemingly inconsequential levels, or at least to those that do not indicate a heavy drinker or user of other drugs.
Even third stage addicts may be responsible for criminal behaviors in between uses. Recall the movies, Lost Weekend and Leaving Las Vegas. Smoothed out when the BAC was at obviously high levels, the main characters were blithering, nervous wrecks in-between drinks while the BAC dropped towards zero. Many spouses tell their addicted loved ones to "go have a drink," since these addicts are easier to deal with high than sober. It's as if they'd had a fight the night before with blows to the head, felt no pain and wake up sober but hurting. Although their cells and brain are in heated battle every time they use, inflicting damage to cells, the drug acts to numb the pain. It's also similar to undergoing an operation; the pain is felt only after the anesthesia wears off. It is possible that many crimes of passion are committed in-between uses.
Many therapists, seeking to explain volatile mood swings and other behavioral problems, look first for bipolar or other psychopathological disorders and/or mental illnesses. While these can be treated therapeutically or with medicine, substance addiction cannot. Yet, addiction can mimic all these disorders and illnesses, which therefore become symptoms of an underlying addiction. Only when the addiction is arrested can other problems be properly treated (if they haven't already dissipated).
Addicts exhibit abrupt mood changes, from depressed and withdrawn to hyper, manic and excited, for no apparent reason. The timing depends on when and which drug was used last, interactions of various drugs with each other and how the addict's particular brain neurotransmitters are affected. Often, these reactions take place in-between uses. The only difference (to the layperson) in observable behaviors of an addict and a bipolar is that if the addict cleans up, the depression and mania (eventually) disappear. Even with as little as a month in recovery, the number of addicts exhibiting sociopathic behaviors (in a study by alcoholism expert Terence Gorski, discussed later) plunged from 90% to 10%.
Alcoholic actress Vivien Leigh was repeatedly diagnosed as bipolar (manic-depressive) even while she drank regularly and heavily. Alcoholism expert Charles L. Whitfield, M.D., said that although "she could have been suffering from both manic-depressive illness [bipolar disorder] and alcoholism, there would have been no way to know until one observed her alcohol- and drug-free for one to three years." Patty Duke's autobiography is suggestive of heavy drinking and other (legal) drug use as a trigger for her bipolar disorder, a possibility Duke doesn't discuss. According to chemical dependency counselors, this disorder doesn't usually appear until the late teen years, well after most have had their first of many drinks. It's possible that other disorders such as sociopathic, schizophrenia and borderline personality might not only be mimicked but also triggered by heavy substance use and/or addiction.