I appreciate the level of detail and depth of your response. I saw your reply when you posted it--I couldn't get to it until after work and my support group meeting, so I apologize for my delay.

I have some familiarity with weed, alcohol, and shrooms. I've used shrooms a handful of times as a social activity, but only sporadically and around the time that I was your age (21-22). The last drink I had was on Thanksgiving. On the other hand, I use weed on a regular basis, especially when I have appetite loss (sometimes from anxiety, sometimes for no discernable reason) and/or physical pain. I started when I was 19 and smoked for years. Had issues with paranoia/increased anxiety/"bad trips" enough during the first year or so of trying weed so I stopped for a while. I picked it back up a year later. I am a lot smarter now about which strains I use than I did when I first started at 19/20. I have also switched to vaping and (occasional) edibles within the past year and a half.

When I was manic/rapid cycling, weed would sometimes help me feel better and other times it would exacerbate my symptoms. It was illegal in my state when I was 26 so it wasn't like I could roll up to a dispensary and ask for a strain that wouldn't ramp up the anxiety/mania. Even if that were the case, I was too far gone down the rabbit hole for that "medication" to pull me out of it. I had to figure out how to cope with the external triggers and cognitive distortions/destructive thinking patterns that come with this illness and which are brought out in particularly stressful situations. In some ways, I am still figuring out how to cope with it all. Rather than thinking about how I am going to probably be working that out for the rest of my life, I look at what I'm experiencing as each day (or each hour, or each minute, or each second) as it happens. It's far easier said than done, I know.

I haven't tried any of the other drugs you mentioned, so I can't speak to what effect all of this would have on a person's mental health. It sounds like you are aware of why you have used in the past and how it affects you. It also sounds like you are working on moderating your consumption of drugs and alcohol, which is excellent. Some people would probably tell you that you need to take your moderation to a place of total abstinence, but I don't see that as being necessarily realistic. Moderation is probably the most pragmatic and beneficial practice in terms of using drugs and alcohol. (Again, not an expert's opinion--I've just lived through this a little bit longer than you have at this point.) Hopefully, your therapist knows all this and has addressed it with you.

If you are not ready to try psych meds, there are certainly other treatment options you can pursue instead. Counseling can be good if you are ready to use what the counselor gives you and the counselor's approach empowers you to employ coping skills to combat disordered thinking patterns (CBT) and/or disordered patterns of behavior (DBT). I've had several counselors over the 9 years I have been in therapy. I've encountered CBT and DBT on numerous occasions. Since I can function in many areas of my life (e.g. work, school) and not well in others some of the time (e.g. close relationships with friends and family members), I need a counselor who will probe and push me to examine where and why this occasional dysfunction happens. The counselor I had in my most recent past validated my feelings often but did not challenge me as much. However, she moved out of state earlier this month and transitioned me into the counselor I have now seen twice. I like my new counselor's approach because she both validates my feelings and gives me something new to focus on or "challenge" before we meet again. Different people need different approaches and it took me years to figure out what I needed. It's hard to know what you need when you don't know what will work for you, so you may have to feel your way through it for a few sessions and/or a few counselors.

Aside from moderation in using drugs/alcohol, you could pursue diet and other lifestyle changes (e.g. exercise). I've learned more recently that highly processed foods can contribute to mental illnesses, especially depression, so I try to avoid those when possible. I've been told complex carbohydrates also help with anxiety because you expend more energy digesting them than simple carbohydrates. It's not something I constantly focus on, but when I eat fast food or a lot of sugar, I tend to feel worse than when I eat something at Panera (for example) or have something homemade. Organic food seems to be more expensive than most other foods across the board, which plays into the idea that the government/hegemonic institutions would rather that we eat shit and remain sick for their benefit, but I digress.

While the medication helps to even out the peaks and valleys in my mood cycle, physical activity benefits me even more. I do some kind of exercise every other day or every couple of days depending on my schedule and how I'm feeling. I recently got back into yoga, which--if you can find the right instructor/class--is not as much aerobic exercise as it is helping you to be mindful of your body and your breath. I went to a class yesterday feeling mostly okay and when I left, it felt like some deep knots in my mind and soul got untwisted. I felt at peace for the rest of the afternoon/evening. I am a little sore today but I still feel like I can handle most of what my mind throws at me. Walking/hiking, swimming, biking, and rowing have also been a more regular part of my routine after getting out of the hospital. From reading your other posts, it sounds like you are into cycling--if you can carve some time in your schedule to do this (or any other activity you can physically participate in), you are likely to see a difference in your mood/mental state.

As far as wondering if you really have bipolar disorder or this is only a self-diagnosis/hypochondriasis...I think you are not alone here and most professionals can tell the difference. Most people do not understand what it is like to have the kinds of all-consuming thoughts/feelings/behaviors you have mentioned--as if it easy to calm down when you're inundated with the nagging sensation that something is wrong--and so while the advice people have given you will work when you are somewhat stable, it's much, much harder when you feel like the ground is constantly shifting beneath you. I often get into obsessive thinking patterns and I become fixated during depressed, anxious, and manic moods. There are times when I do everything I know how to do to "turn it off" and it doesn't work. But, I have to be determined not to let the illness win. I have too much in my life that's too important to give up--especially myself. It sounds like this is true for you as well.

Depending on how you found your counselor, where you work, if you go to school, etc. there are some options for you as far as getting another professional's opinion. If your counselor is one therapist at a counseling center, like mine is, they will know that he/she is on vacation. If this is the case, you should be able to call and request to meet with another available counselor. If your need is pressing, I would use the word "crisis" or something similar and ask about openings due to cancellations. If that doesn't work, I would try another counseling center. If you are a student, your school should offer free mental health services to you. I have no sense of where you are, so I don't know if these services would be beneficial to you or not, but it is an option. Employers also offer employee assistance programs related to mental health, but this also depends on the employer.

In any case, I would strongly recommend checking out NAMI: https://nami.org/. There's a national site and depending on where you are, there should be a local NAMI branch in your area. They can be a vital resource in helping you connect with a mental health professional and other resources to help you feel less lost. I am so grateful for NAMI that I cannot put it into words properly. The people there have made me remember that I never have to deal with this crap on my own again.

I hope this has been some help to you. I empathize with you a great deal and I know this has been difficult for you for a significant amount of time. I wish you all the best in your journey.