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Bipolar Disorder

If left untreated, living with bipolar disorder (BPD) can feel like an emotional roller coaster ride, where the ups and downs of manic-depressive mood swings can leave a person feeling completely debilitated. Now, when bipolar disorder and substance abuse meet, these mood swings can be even more powerful, leading an individual to self-medicate and eventually fall into the hands of addiction.

In order to ease the pain of these symptoms, many people with bipolar disorder turn to drugs or alcohol as a means of self-medicating, often leading to addiction. The U.S. National Institute on Drug Abuse states that the risk for substance abuse is doubled for those with mood disorders, while those with more severe cases are put at an even greater risk.

In fact, experts have indicated that bipolar disorder is more likely to lead to substance abuse than any other mental health disorder, and the combination of the two can be quite dangerous or even deadly. This highlights the need for those with BPD to learn about the risks and consequences of using alcohol or drugs and the importance of treating both conditions together. To learn more about this deadly combination, continue reading below for our bipolar disorder and substance abuse statistics.

Dual Diagnosis

When a person has a combination of mental health illnesses occurring at the same time, they are given what is called a dual diagnosis. Any combination of mental health conditions can qualify, but substance abuse most commonly tends to co-occur with mental illness. Each diagnosis requires its own separate treatment plan, contributing to the level of difficulty of treating co-occurring disorders. Treatment methods that fail to address these conditions at the same time often fail, leaving the patient to fall back on one illness or the other.

It's also important to note that dual diagnosis is not a rare phenomenon; a 2014 National Survey on Drug Use and Health estimated that 7.9 million people in the U.S. simultaneously experience both a mental disorder and substance use disorder. Of this population, 4.1 million are men—that’s more than half.

What is Bipolar Disorder?

While we all experience life’s ups and downs, the mood swings associated with BPD are so severe that they can affect a person’s ability to function in everyday life. Bipolar disorder, much like substance abuse, poses a significant risk to a person’s physical and mental wellbeing, and, ultimately, their life.

Once known as manic-depressive disorder, bipolar disorder (BPD) presents itself in different forms and varies widely from person to person. The illness is characterized by patterns of mood disturbances that vary along a spectrum in terms of severity. Contrary to the way it is often portrayed in the media or described in common conversation bipolar disorder is not defined by a sporadic, quick-fire switch between multiple personalities. Rather, it is a pattern of intense shifts in mood, emotion and energy levels that last for extended periods of time, in some cases, episodes may occur for weeks or even months. While environmental triggers hormonal imbalances, and genetic factors may be causes of bipolar disorder, this will depend on each individual case.

Symptomatic Features of Bipolar Disorder

These mood episodes fall into four major types: mania, hypomania, depression, and mixed episodes. Each type is its own unique set of symptoms.

Mania

Lying at the high end of the mood spectrum, symptoms of mania include:

  • Increased energy levels and activity
  • Feeling wired or jumpy
  • Rapid speech
  • Inability to concentrate; running thoughts
  • Irritability
  • Sleep difficulties; insomnia
  • Feeling invincible or all-powerful
  • Risky and reckless behavior

Hypomania

Hypomania is a less severe form of mania, characterized by similar symptoms such as euphoria and elevated energy levels. In this state, a person may exhibit increased productivity and more outgoing behavior. While a state of hypomania may not interfere with the individual’s ability to carry out day-to-day activities, risky or reckless behavior can negatively impact job performance and cause relationships to deteriorate.

Depression

At the other end of the spectrum, the low symptoms of depression include:

  • A sense of hopelessness and despair
  • Fatigue
  • Memory impairment and concentration
  • Self-destructive behavior
  • Suicidal idealization or attempts
  • Changes in appetite
  • Trouble sleeping or sleeping too much

Mixed Episodes

Symptoms of both mania and depression can be present in a mixed episode. More than half of people experiencing a depressive episode also experience manic symptoms. For example, someone might say they’ve never felt better in their life but at the same time start crying uncontrollably. Evidence shows that the risk of suicide is greatest during this state, and sadly, 10 to 15 percent of people with BPD take their own lives.

Variations of Bipolar Disorder

As mentioned above, bipolar disorder can present itself in different ways depending on the person. Though the most commonly known forms of BPD are bipolar I and bipolar II, there are actually four basic types that account for the variations in symptoms of bipolar disorder. All of these include clear changes in mood and energy.

Bipolar I

The transitions from mania to depression tend to be the most dramatic in individuals diagnosed with bipolar I. Depressive states typically last for about two weeks and are often associated with a high level of functional impairment. Additionally, some manic episodes may be so severe that the person becomes a danger to themselves or others, requiring hospitalization.

Bipolar II

Patterns of depressive and hypomanic episodes are present in those with bipolar II, but unlike bipolar I, full-blown manic episodes do not occur.

Cyclothymia

The symptoms of cyclothymia are similar to those of bipolar disorder but are more mild and chronic in form. A person with cyclothymia will experience numerous periods of highs and lows similar to hypomania and depression, but neither episode necessarily fits all of the diagnostic criteria associated with each. These periods occur for at least two years in adults, and one year in adolescents and children.

Other or Unspecified Bipolar

In many cases, sufferers experience mixed features of bipolar disorder but don't necessarily fit into a certain category as those listed above. A person within this classification of bipolar may feel unusually energized, have trouble sleeping, experience a loss of appetite, and simultaneously have feelings of worthlessness and despair. These cases emphasize the spectrum of bipolar disorder and fall within the category of other specified or unspecified bipolar disorder.

Rapid-Cycling

Rapid-cycling is a manifestation of bipolar disorder whereby a person will rapidly experience multiple alternating episodes of depression and mania. During rapid-cycling, a person experiences at least 4 of these episodes within a 12-month period.

The Brain and Bipolar Disorder

For both substance abuse and bipolar, researchers believe that abnormalities in brain chemistry are at the root of these disorders. Brain chemicals known as neurotransmitters are what contribute to our body’s vital functioning, and control processes such as appetite, responses to stress, sleep, and ultimately our emotions and mood.

The neurotransmitters most responsible for these processes are norepinephrine, serotonin, and dopamine. People with BPD tend to have abnormal levels of these brain chemicals or disruptions to the neural pathways through which they communicate. Using drugs or alcohol can interfere with the way our body processes these chemicals, and for a person with an already disrupted system, using substances can throw the body even more out of whack.

Using drugs can rewire our brain’s reward center, among other things, causing compulsive drug-seeking behavior. With that said, chronic substance abuse can result in physical and/or chemical changes in the brain, which could potentially lead to the development of some form of mood disorder, including BPD.

Bipolar Disorder and Addiction

The Journal of Clinical Psychiatry stated that up to seventy percent of people with bipolar disorder do have a history of substance abuse, exceeding the general population. While there’s no simple explanation as to why so many with BPD struggle with addiction, it is quite common for these individuals to turn to alcohol or drugs in an effort to regulate mood swings and changes in energy level.

Substance abuse can take place in both manic and depressive states. In a manic phase, some may use stimulants such as cocaine or methamphetamine to prolong feelings of euphoria, while others use sedatives to calm levels of high energy. In a depressive episode, one may use stimulants in an effort to elevate mood, while others seek to lessen feelings of hopelessness through the use of alcohol or tranquilizers.

Substance abuse can affect the outcomes of bipolar disorder in the following ways:

  • Prolonged duration of emotional instability
  • Exacerbated symptoms associated with mood swings, such as impaired judgment, irritability, and feelings of despair
  • Increased suicidal ideation and attempts
  • Diminished quality of life

Alcohol is the most commonly abused drug by people with BPD, primarily due to its numbing effects. Many drink alcohol to weaken symptoms of mania or calm feelings of helplessness experienced during depressive states. While this may off-set negative symptoms for a short period of time, drinking alcohol and taking drugs is known to cause an opposite effect, triggering episodes of mania and depression and worsening their effects.

Many of the symptoms present in both substance abuse and bipolar disorder are similar and overlap, making it hard to discern whether a person is struggling with one condition or the other, or both at the same time. This requires intensive, professional attention to the thoughts and behaviors of a person suspected of mental illness.

Treatment

Treating bipolar and substance use disorder is a very complex process and can be quite difficult in nature. Unfortunately, many rehab facilities are not equipped to treat co-occurring disorders, and programs that lack comprehensive care leave the individual at high risk for relapse.

It is important to note that the willingness of the individual may determine the success of the substance abuse and bipolar disorder treatment. If a person is in denial and unwilling to acknowledge the problem at hand, the process of recovery can be extremely difficult. Thus, it is important to find a program that will support the patient’s own pace and unique needs. This may mean starting smaller and working your way up to higher levels of care.

The most effective way to treat these co-occurring disorders is through a process called “integrative treatment”, where a number of treatment strategies are utilized to heal the person as a whole.

Common features of integrative treatment include:

  • Facilities where care is centralized and provided in a single treatment center
  • A team that specializes in dual diagnosis care, where psychologists, addiction counselors, and trained medical professionals collaborate in treatment
  • Closely monitored psychiatric medication used to treat mood swings
  • Individualized psychotherapy that equips the patient with management techniques and coping skills
  • Group support from peers that are also battling the conditions

Treatment planning is different for each person, but some of the common elements in treating the co-occurrence of bipolar and substance use disorder include the following:

Detox

Detoxifying the body of drugs and alcohol is one of the biggest hurdles in the treatment of bipolar and substance abuse, but it’s also one of the most vital obstacles as well. If someone with bipolar disorder is receiving treatment but chooses not to refrain from drinking or using drugs, any efforts of mood stabilization by means of medication or even talk therapy will be compromised. That being said, detox is most effectively accomplished in an inpatient treatment setting, where the patient is removed from any potential opportunities to use. Inpatient rehabilitation centers have 24/7 care, where the patient can be closely monitored and receive immediate support for any withdrawal symptoms.

Medication

When treating someone for BPD, typically the first step involves stabilizing their mood via medication. Medication is highly effective in restoring abnormalities in brain chemistry, mood, and energy levels. However, the medications need to be chosen and monitored carefully, as some medications can trigger manic episodes or worsen other side effects.

Though there is sometimes a negative bias or fear surrounding the use of medication, it is important to take on a different perspective: when someone is struggling with BPD it is likely that they are experiencing a chemical imbalance within their brain—something that can be treated through the use of medication, among other things. Medication is used to treat a wide variety of mental conditions, just like you would any other chronic illness, such as diabetes. However, treatment has proven most effective when medication is used in conjunction with cognitive behavioral therapies.

Behavioral Therapies

In order to address the complexity of bipolar disorder when combined with substance abuse, it is important to include multiple therapeutic techniques that address the psychological, physical, neurological, and psychosocial components of the individual. One of the most common client-centered approaches is the process of motivational interviewing (MI), whereby the patient and therapist collaborate together to define goals in treatment and develop strategies to accomplish those goals.

Additionally, Cognitive Behavioral Therapy (CBT) is one of the most effective ways to treat mood disorders. The use of CBT allows the individual to acknowledge the distortions in their patterns of thinking, and how those distorted thoughts contribute to destructive behavior, anxiety, depression, and more. The person is then taught to replace self-defeating thoughts with more positive coping strategies

Support

Coping with a dual diagnosis can feel extremely isolating, which makes finding outside support absolutely essential. Community support groups create a space for people to share their frustrations, insight successes, and offer self-help tips. Support groups, such as Alcoholics Anonymous (AA), also serve as a meeting-ground for healthy friendships that encourage one another to stay clean.

Conclusion

For many, battling bipolar disorder is a significant challenge; the drastic transitioning of one emotional state to another is exhausting, both physically and mentally. In an effort to gain peace of mind, many turn to drugs and alcohol and lead themselves to addiction. Substance abuse co-occurs in youth with BPD so frequently that many are required to complete a drug screen at the time of diagnosis.

When combined with substance abuse, managing bipolar disorder becomes increasingly more difficult; each condition is progressive in nature and will continue to get worse if left untreated. This calls for integrative and holistic treatment methods that address both conditions simultaneously. Bipolar disorder is not necessarily preventable, but by knowing the signs, symptoms, and risks associated with BPD and substance abuse you can help prevent addiction.

Though bipolar disorder is a life-long condition, it can be managed through the use of medication, therapy, and various lifestyle changes that will allow you to live a clean, healthy, and happy life. If you or a loved one is struggling with a mood disorder and/or substance abuse, Peaks Recovery is here to help. Call us today to talk to our experienced professionals and get the treatment you deserve.