Bipolar disorder, once commonly known as manic depression, is a serious mental disorder that is characterized by sudden and intense shifts in mood, behavior and energy levels.
Like substance abuse, bipolar disorder poses a risk to the individual’s physical and emotional well-being. Those afflicted with bipolar disorder have a higher rate of relationship problems, economic instability, accidental injuries and suicide than the general population. They are also significantly more likely to develop an addiction to drugs or alcohol.
According to statistics presented by the American Journal of Managed Care:
- About 56 percent of individuals with bipolar who participated in a national study had experienced drug or alcohol addiction during their lifetime.
- Approximately 46 percent of that group had abused alcohol or were addicted to alcohol.
- About 41 percent had abused drugs or were addicted to drugs.
- Alcohol is the most commonly abused substance among bipolar individuals.
If you are struggling with bipolar disorder and with a drug or alcohol problem, you may have a Dual Diagnosis of bipolar disorder and substance abuse. Having a Dual Diagnosis, or a co-occurring disorder, can make recovery more challenging. Bipolar individuals may experience periods of intense depression alternating with episodes of heightened activity and an exaggerated sense of self-importance. This emotional instability can interfere with your recovery program, making it difficult to comply with the guidelines of your treatment plan.
Dual Diagnosis rehabilitation programs are designed to meet the needs of clients who are faced with this complex psychiatric condition. Staffed by specially trained and credentialed mental health professionals and addiction specialists, these centers offer care that integrates the best treatment strategies for bipolar disorder with the most effective treatments for addiction.
How Are Bipolar and Addiction Related?
There is no easy explanation for the high rate of substance abuse and chemical dependence among bipolar individuals. One reason for this phenomenon is that a large percentage of individuals attempt to self-medicate with drugs and alcohol in an effort to numb the painful symptoms of their bipolar disorder.
Symptoms of bipolar disorder such as anxiety, pain, depression and sleeplessness are so alarming, that many individuals will turn to drugs and alcohol as a means for offsetting the discomfort, if only for a little while. On the other hand, the National Institute of Mental Health notes that drinking and using drugs may trigger depressed or manic moods in someone with bipolar disorder.
Age and gender may play a part in the relationship between bipolar and addiction. According to the journal Bipolar Disorder, substance abuse is more common in young males than in other population groups. Young men are more likely than females or older men to take dangerous risks or to act on serious self-destructive impulses. In elderly individuals with bipolar disorder, the incidence of substance abuse is much lower.
Clinical researchers believe that brain chemistry may influence both bipolar disorder and substance abuse. People with bipolar disorder often have abnormal levels of serotonin, dopamine and norepinephrine, according to WebMD. These chemicals affect vital functions like appetite, metabolism, sleep and your body’s response to stress. They also affect mood and emotions.
People with bipolar disorder may turn to drugs or alcohol out of an unconscious need to stabilize their moods. Unfortunately, substance abuse has the opposite effect, making the symptoms of bipolar disorder worse.
Symptoms of Bipolar Disorder
We all go through intense episodes of sadness, elation, anger or despair. But for someone who meets the diagnostic criteria for bipolar disorder, these episodes are all-consuming and uncontrollable. There are four major types of mood episodes that characterize bipolar disorder: mania, hypomania, depression and mixed episodes — each of which has a set of unique symptoms:
Mania is the “high” end of the mood spectrum for bipolar individuals. Symptoms may include:
- Moments of tremendous optimism and significant pessimism
- Grandiose feelings
- Rapid talking
- Little sleep
- Impaired judgment, irrational behavior
- Delusional behavior
Symptoms are similar to those found in manic behavior but less intense. Hypomanic individuals are usually capable of managing their day-to-day lives, but they experience a higher than usual level of happiness, irritability or energy. You may feel that you’re capable of taking on more responsibility, or that you need less sleep. People in your life may find that you’re more talkative or sociable.
You may also be more prone to engage in risk-taking behaviors, like substance abuse. Hypomanic periods are extremely productive for some people, and because psychotic symptoms do not occur in hypomania, it might seem that you don’t really have a problem.
At the “low” end of the bipolar spectrum is depression, an emotional state that is often characterized by sadness, tearfulness and despair. Depression in bipolar disorder may last for days or weeks, depending on your mood cycle. These periods are dangerous for Dual Diagnosis individuals, who have a higher risk of self-injury and suicide when they’re using drugs and alcohol during a low period.
When you’re depressed, you may experience:
- Hopeless feelings
- Loss of interest in things that used to make you happy
- Changes in appetite
- Suicidal thoughts
The symptoms of bipolar disorder aren’t always clearly defined. In a mixed episode, behaviors reflect a combination of mania and depression. For example, you may have suicidal feelings and a loss of interest in your daily activities, combined with racing thoughts, pressured speech and a loss of sleep.
You may feel the urge to drink or take drugs in an attempt to balance out these unpredictable mood swings, but intoxication is only a temporary fix that won’t provide permanent relief. To achieve a full recovery, you need professional treatment that helps you stabilize your moods as you deal with the cravings and destructive impulses that characterize addiction.
Treatment for Bipolar and Addiction
In the past, bipolar disorder and chemical dependence were addressed as separate conditions and treated at separate facilities. People who were diagnosed with bipolar disorder were referred to mental health treatment centers or psychiatric hospitals, while those who were actively abusing drugs and alcohol were sent to rehab.
Today, addiction professionals recognize the importance of treating bipolar disorder and substance abuse at the same time through a process called “integrated treatment.”
Integrated treatment encompasses a number of different treatment strategies. Your treatment plan might include one-on-one psychotherapy with a mental health professional, counseling sessions with addiction specialists, Dual Diagnosis support groups, family counseling and holistic therapy.
Features of an integrated program for bipolar disorder and addiction include:
- Centralized care provided in a single rehabilitation facility
- A collaborative treatment team that includes psychologists, addiction counselors, and other professionals trained in Dual Diagnosis care
- Individual psychotherapy that focuses on managing your emotions and minimizing the risk of substance abuse
- Psychiatric medication to help you handle the ups and downs of bipolar disorder
- Peer group support from others who are battling addiction and a mood disorder
It’s not enough to treat bipolar disorder without addressing the problem of substance abuse, and vice versa. Unless you receive comprehensive care for both conditions, your chances of relapse are high. Relapse prevention strategies for an individual with bipolar disorder must include coping skills for managing the psychological and emotional triggers for substance abuse.
Therapeutic approaches like Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) have proven useful in teaching Dual Diagnosis patients how to regulate their emotions and avoid being overwhelmed by dramatic mood changes.
Group support is crucial to recovery when you have a Dual Diagnosis of bipolar disorder and a substance use disorder. In peer group support meetings and counseling sessions, you’ll learn about the common triggers and risk factors that people with bipolar disorder face in recovery. You’ll have the opportunity to share your experiences with others and to acquire new coping strategies from your peers.
In dual diagnosis treatment centers, the importance of psychotherapeutic medication in treating bipolar disorder is widely acknowledged. Mood-stabilizing medications may be used in combination with antipsychotic drugs or antidepressants to provide complete support for your recovery goals.
Challenges to Recovery
Addiction professionals face a number of challenges when it comes to treating bipolar patients with addiction issues. For one thing, many of the symptoms of bipolar disorder are similar to those of drug and alcohol abuse. Therefore, if a person does seek out professional help, it is difficult to see where the mental disorder stops and the addiction begins.
Also, even the most well-meaning drug rehab programs are likely to be unable to identify the concurrent bipolar disorder that a patient is experiencing. Many do not get the help they need and are asked to leave the rehab program because they are not responding to the traditional forms of treatment.
During a depressive episode, for instance, a lack of motivation or low energy levels can interfere with treatment plans. In a manic state, rehab clients may appear to be unfocused, overly talkative, impatient, aggressive or grandiose.
The U.S. Department of Health and Human Services emphasizes that treatment for co-occurring disorders should proceed at the individual’s own pace, and that the treatment plan must be evaluated and modified to meet the Dual Diagnosis patient’s unique needs.
In order to deal with the complexities and challenges of bipolar disorder, each member of the treatment team should have a professional background in mental health care as well as addiction and rehabilitation. The members of the team must communicate with each other and with the client on an ongoing basis to make sure that the treatment plan is effective.
Facilities that specialize in Dual Diagnosis treatment understand the overlapping nature of bipolar disorder and substance abuse. These dedicated treatment centers can provide appropriate treatment at a pace better suited for the person with bipolar disorder. Treatment centers in California and Tennessee are staffed by experts who understand what it takes to help an individual with a co-occurring disorder get well again. These well-regarded institutions change lives. They help treat both bipolar disorder and addiction with equal care and thoroughness.
Contact us immediately at 844-567-9906 if you or someone you love suffers from addiction and mental illness. Remember, only those who work with Dual Diagnosis patients on a regular basis are equipped to handle the special nature of the illness.
Relevant Topics of Discussion
Further Reading About Bipolar Disorder and Addiction
- A Symptoms Checklist
- Bipolar Disorder and Klonopin Abuse
- Bipolar II
- Cyclothymic Disorder
- Intervention for Manic Episodes
- Isolation and Bipolar Disorder
- Mixed Bipolar Disorder
- Protecting Your Children by Finding Healing for Yourself
- Rapid-Cycling Bipolar Disorder
- Self-Absorption and Bipolar Disorder
- Stimulant Use
- Substance Abuse and the Risk of Suicidal Ideation
- The Costs of Bipolar Treatment Services
- Untreated Bipolar Disorder Can Lead to Increased Risk of Domestic Violence
David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.
Reviewed by: Kim Chin and Marian Newton