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Bipolar Disorder: How Mental Health Can Mimic Drug Use Without the Drugs

Bipolar disorder is one of the most misunderstood mental illnesses, and for good reason. Often, the behavior of a person who is in the throes of a manic episode can resemble an individual who is on drugs, but this is not always the case.

Bipolar, once referred to as manic depression, is a mood disorder that causes people to feel intense emotions that swing wildly between deep depression and mania. While in a depressive state, the individual will be withdrawn, antisocial, uninterested in participating in normal activities, and may sleep a great deal. While in a manic phase, their thoughts will race, they may not sleep for days at a time, will be hyperactive, and often unrealistically happy, powerful, over-confident, optimistic, or even hostile, aggressive, and violent. The emotions they are feeling can turn on a dime, causing the person to go from being extremely happy to crying hysterically, often within seconds. During a manic phase, they may also engage in extremely risky behavior, and will likely act impulsively, saying or doing things that are largely out of character and sometimes outright dangerous.

In between depressive and manic episodes, the individual will likely have periods of wellness in which they function completely normally, going to work, school, or going about their business in a way that is expected of them. For some, bipolar episodes may be more frequent than in others. For those who are considered to be less extreme cases of bipolar disorder, they may only experience one or two episodes in their lifetime.

For others, it may happen more frequently. Some may experience depression more often than mania, and vice versa – however, manic episodes are often followed by depression, stemming from activities or behaviors that may have arisen during the manic phase. Most bipolar episodes of depression or mania last for a period of time, sometimes days or weeks, but others may have bipolar episodes that swing back and forth quickly.

Types of Bipolar Disorder

There are two main types of bipolar disorder. Type I is characterized by manic or mixed episodes, followed by a major depressive episode. Type II is distinguished by major depressive episodes followed by a manic episode. Type I is considered to be the more severe of the two, as any prolonged period of mania can lead to dangerous and potentially life-threatening behavior for the sufferer as well as for their families and loved ones.

Bipolar Disorder and Addiction

Many addicts suffer from co-occurring disorders. Though it isn’t fully understood why this is true, it seems that people with bipolar are far more likely to abuse drugs or alcohol. In fact, one study concluded that approximately 60% of people with bipolar disorder are addicts or at least had some history of substance abuse.

Another concerning statistic is that people with absolutely no history of mental illness can develop bipolar disorder as a result of drug use. It would seem that the two go hand in hand; one can easily mimic the other, even if “the other” is not present. Individuals who are high on cocaine can often appear to be having a manic episode, and it is also true that people having a bipolar manic episode may appear to be high on cocaine. This is a concerning fact, as the two require a very different approach in treatment, both in the short and long-term.

Drug abuse is very common in those who suffer from bipolar disorder. For the sufferer, it may appear that drugs and alcohol are the perfect way to self-medicate, either to take them higher or to take the edge off. The fact that symptoms of bipolar disorder can so closely resemble drug intoxication is worrying, and if a dual diagnosis is a possibility, it needs to be treated by a clinician specialist who is experienced in this type of treatment.

Symptoms of bipolar mania include:
  • Hyperactivity
  • Edginess, irritability
  • Over-inflated confidence or sense of power
  • Little need to sleep
  • Extreme talkativeness
  • Thoughts racing
  • Inability to pay attention to anything for more than short bursts
  • Risky or dangerous behavior
  • Angry or violent outbursts
  • Preoccupation or obsession over a person, or a specific goal

For some, a manic episode may make it impossible to function normally at work or in a social setting. They may require hospitalization, but if addiction is also present, it may make it difficult or impossible to diagnose the underlying condition.

Symptoms of bipolar depression include:
  • Feeling hopeless, worthless
  • Weight loss or weight gain
  • Extreme restlessness
  • Inability to sleep (insomnia)
  • Sleeping too much
  • Lack of interest in the things they normally enjoy
  • Extreme fatigue
  • Foggy thinking
  • Poor memory
  • Self-destructive behavior
  • Extreme feelings of guilt or remorse
  • Inability to concentrate or focus
  • Suicidal thoughts

This type of episode leaves the individual unable to function in their day-to-day lives, whether that involves work, school, or social activities. To meet the clinical definition of a major depressive episode, it has to last for a period of at least 2 weeks. While it is not the result of drug abuse, a major depressive episode can mimic the symptoms of drug withdrawal.

How Bipolar Disorder is Diagnosed

While there are some crossover behaviors that can easily be attributed to drug abuse or addiction behaviors, bipolar disorder is notoriously difficult to diagnose, especially in the presence of drug abuse.

There are several physical and psychological tests that doctors will administer to determine what they are dealing with and the correct course of bipolar disorder treatment. These include:

Physical examinations. The clinician will examine the patient’s medical history, as well as that of their parents and close relatives, as there is a tendency for bipolar disorder to run in the family. The patient’s history of drug use will be brought into the equation in order to understand the underlying cause of the bipolar disorder and to help devise an appropriate treatment plan.

Psychological examinations. The caregiver will interview the patient about his or her thoughts and feelings, and may also ask to speak to their friends and family members to find evidence of depressive or manic behavior.

Mood charts. The doctor will likely ask the patient to record their moods on a daily basis. By establishing patterns of behavior, it will be easier for them to develop an accurate diagnosis.

The doctor will compare the patient’s symptoms to other conditions that have common identifiers. This is due to the fact that a person can have major depression without being bipolar, and substance intoxication and addiction can often mimic the outward effects of bipolar mania.

Is it Drugs? Or Is it Bipolar Disorder?

Since the symptoms of both of these disorders can be very similar, the patient needs to be assessed by a caregiver who is a specialist in dual diagnosis. Symptoms can overlap, and it is often very difficult to distinguish between one and the other.

One of the mitigating factors they look for is whether the patient was having episodes (either manic, or depressive, or both) prior to the onset of the drug abuse. If the behavior was present without the drugs, it is easier to determine that bipolar may be the core issue. If the bipolar behavior began as a result of the drug abuse, it can be much harder to tell. The importance of obtaining the correct diagnosis cannot be stressed enough, as both issues can be treated separately or together, but in the case of drug abuse, and depending on the patient’s drug of choice, some medications may not be as effective or can even exacerbate the behavior.

Medications that are strictly for bipolar disorder can bring a great deal of relief to a patient’s life, helping them to normalize their moods and to better function in their day-to-day lives. Some of these drugs include:

  • Antipsychotics (haloperidol, chlorpromazine, trifluoperazine)
  • Anticonvulsants (acetazolam, carbamazepine)
  • Lithium
  • Benzodiazepines (valium, clonazepam, lorazepam)

Benzodiazepines, however effective they may be at controlling bipolar symptoms, are addictive over the long-term and may present further issues for patients with dual diagnosis.

Cognitive Behavioral Therapy

Also known as CBT, cognitive behavioral therapy helps patients suffering from addictions and bipolar disorder to better understand their thoughts and feelings as well as the triggers that precede their episodes and behavior. This allows them to better prepare to manage the symptoms as they arise.

Obtaining a Proper Diagnosis

As it is often difficult to obtain a clear diagnosis for bipolar, it is important to press on. Individuals who suffer from bipolar will often refuse treatment, or check themselves out of hospital as soon as they are able, and so receiving a proper diagnosis is an elusive endeavor – especially for young adults who can legally speak for themselves.

Continuing on with a medication protocol is also difficult at times, as the patient may dislike the side-effects of the medication and feel that if they are doing well that they don’t need it. Once they discontinue the medications, the behavior may come back quickly, and the cycle starts anew.

Peaks Recovery Centers in Colorado Springs, Colorado

If you suspect your child or a loved one is affected by bipolar disorder, drug addiction, or a combination of both, you owe it to yourself and your family to seek help from a medical specialist who is qualified in dual diagnosis. Above all, it is important that you are treating the cause and not just the symptoms. At Peaks Recovery Centers, we are here to help. We specialize in long-term, age-specific and gender-specific treatment for young adults with substance or alcohol abuse issues as well as psychological and behavioral disorders. Call today to find out more.