The relationship between bipolar disorder and substance abuse is complex. People with bipolar disorder often turn to substances to self-medicate and alleviate the intense emotional roller coaster they experience during manic or depressive episodes. However, research suggests that people with a dual diagnosis of bipolar and addiction don’t respond well to treatment and have a poorer recovery prognosis.
How common is a dual diagnosis, and what treatment options are available?
Prevalence of Substance Abuse Among Individuals With Bipolar Disorder
Bipolar disorder is a chronic mental health condition that affects a person’s mood, energy level and ability to function on a day-to-day basis. People with bipolar experience recurrent episodes of elevated mood and depression. Manic and hypomanic episodes may include feelings of extreme happiness or excitement, high energy levels, racing thoughts, lack of need for sleep, excessive talking and poor impulse control. During a depressive episode, people may experience low mood, hopelessness, decreased self-esteem and no interest in activities they once enjoyed.
According to the Substance Abuse and Mental Health Services Administration, between 30% and 50% of people diagnosed with bipolar are at risk of suffering from a substance abuse disorder. While scientists haven’t come to a definitive conclusion to explain the correlation between bipolar and addiction, substance abuse occurs more often with bipolar disorder than with any other mental health condition.
Alcohol is the most frequently used substance, but people with bipolar also turn to stimulants such as cocaine, as well as cannabis and nicotine.
Substance Abuse Can Interfere With Treatment
Bipolar disorder can be difficult to treat, but adding alcohol and illicit drugs to the mix can exacerbate the condition and make treating it even more challenging. Individuals with a bipolar dual diagnosis may be more resistant to treatment, as substance abuse can hinder progress and lead to longer periods of unstable moods.
Alcohol and illicit drugs may interact with medications typically prescribed for bipolar disorder and make them less effective. The interactions between prescribed medications and alcohol or other substances can make bipolar symptoms worse, while some drugs such as stimulants can increase potential danger during a manic episode.
People with bipolar are more likely to discontinue their medication and not engage in therapy when abusing drugs and alcohol. When patients with bipolar disorder self-medicate with substances, they can inadvertently make their symptoms worse. Drugs and alcohol trigger the very feelings the person was trying to avoid, leading to more frequent and severe manic or depressive episodes. Substance-induced mania or depression makes it harder for clinicians to tell the difference between the symptoms of bipolar disorder and substance abuse, especially since some drugs can mimic bipolar symptoms or even trigger the onset of the condition.
Shared Risk Factors and Underlying Mechanisms for Bipolar and Addiction
Bipolar disorder and substance abuse share a complex relationship, and scientists aren’t completely sure why the conditions co-occur more often than not. But research has found certain risk factors connecting the two disorders.
- Neurotransmitter imbalances. Both bipolar disorder and substance abuse can cause dysregulation of neurotransmitters such as dopamine, serotonin and norepinephrine. The interaction between these systems increases the chances of developing both conditions.
- Genetic influences. Both bipolar disorder and substance abuse have a strong genetic component. Studies have found shared genetic markers that heighten the risk of developing both conditions.
People with bipolar disorder can turn to drugs and alcohol as coping methods for mood swings or symptoms of depression. The condition can also co-occur with mental health disorders such as anxiety, post-traumatic stress disorder (PTSD) and attention deficit hyperactivity disorder (ADHD). Substance abuse often accompanies these conditions, but instead of offering relief, using substances worsens the underlying disorder and can turn into an addiction.
Sometimes, substance abuse causes the appearance of bipolar disorder symptoms. Addiction can even trigger the onset of bipolar in vulnerable individuals, which is why it’s difficult for clinicians to diagnose some people with co-occurring conditions. In many cases, it’s almost impossible for a psychiatrist to determine which condition came first.
An Integrated Approach for Bipolar Dual Diagnoses
The most efficient way of treating a dual diagnosis is using an integrated approach to both conditions. A mental health team experienced in treating co-occurring conditions may recommend treatment options such as:
- Prescription medication. Bipolar can be treated with medications such as antidepressants, antipsychotics and mood stabilizers, while doctors may prescribe drugs to reduce cravings and help with substance withdrawal. Some medications for bipolar disorder can also help reduce a person’s cravings for substances.
- Psychotherapy. Individuals with a dual diagnosis may benefit from evidence-based therapy methods, including modified cognitive behavioral therapy and early recovery adherence therapy, centering on recovery from addiction and managing bipolar.
- Group therapy. An integrated approach to group therapy combines 12-step recovery meetings with relapse-prevention plans.
- Inpatient treatment. Some dual-diagnosis patients may benefit from a medically assisted detox and rehabilitation at a residential treatment facility.
Helpful Strategies for Managing Addiction and Bipolar
Bipolar and substance abuse are serious conditions on their own. It’s important to seek mental health treatment if you’re experiencing symptoms of either or both of these disorders. Along with seeking an integrated treatment program, here are some additional strategies that may help you manage your condition.
- Self-help support groups. Try joining a support group for people with co-occurring bipolar disorder and substance abuse. In groups such as the 12-step-based Dual Recovery Anonymous, you may find a safe and understanding environment to share experiences and get support from peers who can relate to the challenges of dual diagnosis
- Stay on your medication. A dual diagnosis is a serious mental health condition. It’s crucial you continue taking your medication as prescribed by your doctors and discuss any potential changes with them.
- Research your conditions. Educate yourself about bipolar disorder and substance abuse to better understand the two disorders and how your symptoms manifest.
- Build a support network of trusted family members and friends. A strong support system may offer you encouragement and help you stay accountable throughout your journey to recovery.
- Change unhealthy habits. Try adding regular exercise and balanced nutrition to your daily routine, and make sure you get enough sleep.
A dual diagnosis of bipolar disorder and substance abuse can be hard to manage, but you don’t have to do it alone. The compassionate team at Restore Mental Health is available to talk to you 24/7. Contact us now and begin your recovery journey.
