Bipolar Disorder and Substance Abuse
What Is Bipolar Disorder?
Bipolar disorder is a psychiatric disorder that has 3 main subtypes, including bipolar I disorder, bipolar II disorder, and cyclothymic disorder, according to the American Psychiatric Association (APA).6
Also Known as manic depression, is a mental health disorder characterized by mood swings and changes in energy levels that affect a person’s well-being and ability to function. According to the National Institute of Mental Health (NIMH), bipolar disorder appears to affect men and women with equal frequency — in the past year, around 2.8% of the population suffered from the disorder, with around 4.4% of adults experiencing it at some point in their lives. Bipolar disorder can be debilitating — the same NIMH data showed that 82.9% of people with bipolar disorder suffered from a serious impairment, making bipolar disorder the mood disorder that causes the highest level of impairment.1
Bipolar disorder is considered to be a Serious Mental Illness (SMI). Although there are no specific statistics on the prevalence of bipolar disorder in Nevada, available data from the 2018 Southern Nevada Behavioral Health Annual Report shows that the number of emergency room visits due to bipolar disorder in Southern Nevada increased from 4,456 admissions in 2009 to 12,841 in 2017.2 In addition, the most recent Substance Abuse and Mental Health Services Behavioral Health Barometer report for Nevada shows that the prevalence of SMI in Nevada is similar to the national level, with around 4.4% of adults experiencing SMI in Nevada, compared to 4.1% for the rest of the U.S., as of 2014-2015. 3
If you or someone you care about have bipolar and addiction, you should know that you’re not alone. Bipolar and substance abuse commonly occur together, with a report in the journal Psychiatry Research indicating that around 50% of people with bipolar disorder suffer from a substance use disorder at some point in their lives, while another study in the Australian & New Zealand Journal of Psychiatry reports a comorbid prevalence rate of up to 60%.4 This article will help you understand the relationship between bipolar disorder and substance abuse and how to seek treatment if you or someone you care about are struggling with bipolar disorder and substance use.
Common Symptoms of Bipolar Disorder
The defining features of bipolar disorder are alternating episodes of mania and depression that affect your overall life and the way you feel.9 The APA explains that bipolar I means a person has manic episodes that last at least 7 days or has severe manic episodes that require hospitalization. People also (but not always) tend to experience depressive episodes afterward, which last around 2 weeks. Bipolar II involves manic and depressive episodes, but the manic episodes are less severe than those in Bipolar I. Cyclothymic disorder is characterized by episodes of hypomania (meaning a less-severe form of mania) alternating with depressive episodes, but they are not as severe as with full-blown bipolar diagnoses.6
A manic episode is defined by the APA’s Diagnostic and Statistical Manual of Mental Disorders (DSM-V) as a noticeable period of “abnormally and persistently elevated mood” that lasts at least one week and involves at least three of the following criteria, including:7
- Grandiosity or an inflated sense of self-esteem.
- Decreased need for sleep — you might feel you need as little as 3 hours of sleep a night.
- Feeling more talkative than usual.
- Flight of ideas, meaning you have racing thoughts that constantly change and are only loosely associated.
- Feeling easily distractable.
- Increased goal-directed activity, meaning you feel like you want to constantly be doing something at work, home or school, or you experience psychomotor agitation, meaning purposeless activity.
- Being excessively involved in activities that can cause painful consequences, such as gambling, spending too much money, or making other poor life choices.
On the other hand, a depressive episode means you meet at least 5 of the following criteria, including:7
- Depressed mood, such as feeling sad or hopeless.
- Having significantly less interest in your usual activities.
- Significant weight loss or weight gain.
- Sleeping too much or too little every day.
- Psychomotor agitation or retardation (a slowing down of thoughts and movements).
- Fatigue or little energy.
- Feeling worthless or excessively guilty.
- Inability to concentrate.
- Recurrent thoughts of death or a desire to commit suicide, with or without an active plan.
How is Bipolar Disorder Treated?
Bipolar disorder typically gets worse if left untreated. This is why it’s crucial to seek help if you think you have bipolar disorder. It is typically treated with a combination of medication, psychotherapy, self-help strategies, and complementary approaches. This may include:8
- The type of medication that is best can vary from person to person. Sometimes you need to try more than one to see what works. Some of the typical medications that may be used include mood stabilizers, second-generation (“atypical”) antipsychotics, or antidepressants. This can include lithium, a mood stabilizer that helps prevent the highs and lows of the disorder, anticonvulsants, such as valproic acid or carbamazepine, which also act as mood stabilizers, second-generation antipsychotics, of which only quetiapine and the combination of olanzapine and fluoxetine (Symbax) are approved by the FDA to treat bipolar disorder, and standard antidepressants, but they may not be right for everyone because they could trigger mania.
- You may receive different forms of talk therapy, such as cognitive-behavioral therapy (CBT) to help you identify and change negative thoughts and behaviors, family-focused therapy, or individual therapy to help you learn better ways to cope and take care of yourself.
- Self-help strategies, which empower you to take control of your mental health. This may include education about recognizing the onset of symptoms and what you can do if that happens.
- Alternative or complementary therapies, which are not a replacement for medication or psychotherapy but may be a helpful adjunct. This can include exercise, yoga, meditation, or other holistic options.
How are Bipolar Disorder and Addiction Related?
Co-occurring addiction and bipolar disorder self-medication are common because people often use drugs or alcohol as a way of self-treating or easing their symptoms. This may be the case for people who have an undiagnosed, untreated, or undertreated disorder in which their condition has not received the proper diagnosis or the right care to help manage symptoms. They may use substances as a way of managing emotional distress; in fact, one study found that around ¼ of all people with mood disorders (which included bipolar for the purposes of this study) self-medicated with drugs or alcohol.11
Other reasons why bipolar disorder and addiction co-occur may be due to genetic factors. One study in the journal European Psychiatry explains that alcohol use disorders and bipolar disorder appear to share common genetic factors.12
A paper published in the journal Nature discussed the potential correlation between personality traits that are common to people with bipolar disorder and addiction and explains that this may also be one reason why some people with bipolar disorder engage in substance abuse. Personality characteristics like poor impulse control, anxiety, and other temperamental predispositions can influence the development of addiction.13
It is important to take any approved medication that is prescribed to you if you have bipolar disorder. You may worry that these medications could pose an addiction risk. While mood stabilizers are not addictive and do not cause euphoria, they can cause dependence, meaning that your body adapts to the presence of the drug and you can experience withdrawal symptoms if you stop using them. This is why you should not stop taking medication unless under the guidance of a doctor.14
According to the National Alliance on Mental Illness, most medications for bipolar disorder are not addictive and do not cause cravings, unlike those commonly used to treat anxiety or sleep disorders.15 It is therefore unlikely that they would pose an addiction risk to others if they should start taking them or misusing them. However, you should not mix lithium with illicit drugs like ecstasy because it can raise lithium levels in your body.16
Bipolar Disorder and Alcohol Abuse
Bipolar disorder and alcohol are not a good combination, as it can be dangerous to drink alcohol if you have bipolar disorder. Manic depressive alcoholics should seek bipolar alcohol addiction treatment to avoid negative consequences, as alcoholism and bipolar disorder can worsen each other. Alcohol abuse is associated with a higher risk of suicide in people with bipolar and can impair your functioning and increase your symptoms.17 In addition, a clinical review in Current Psychiatry Reports reported that alcohol use disorder and bipolar disorder are associated with increased problems such as a longer withdrawal period from alcohol, increased severity of mania and depressive symptoms, a poorer prognosis, increased morbidity, and overall decreased functioning.18
One study in the Journal of Clinical Psychiatry examined bipolar and alcohol addiction and found that even drinking relatively small amounts (an average of 3.8 weekly drinks for men and 1.2 weekly drinks for women) was associated with manic episodes in people with bipolar I or bipolar II.19
Another study in JAMA Psychiatry explains that people who first developed an alcohol use disorder followed by bipolar disorder had a greater chance of experiencing bipolar alcohol psychosis.20
In addition, taking lithium and drinking alcohol can cause you to feel drowsy, as well as cause dehydration, which can raise lithium levels in your body.16
Integrated Treatment for Bipolar Disorder and Addiction
Co-occurring treatment, also known as dual diagnosis treatment or integrated treatment, is one of the most advisable forms of treatment for people suffering from addiction and mental health problems like bipolar disorder. It involves coordinated substance abuse and mental health services “within a single site or between treatment sites” to provide a comprehensive treatment approach.21 3.3
Combined bipolar and drug abuse treatment can help address both issues, which is necessary to overcome addiction and manage bipolar symptoms. This is beneficial instead of treating each disorder separately; separate courses of treatment could mean that the untreated disorder goes overlooked, or worsens. As a clinical review in Current Opinion in Psychiatry explains, integrated intervention is the treatment of choice for people with a dual diagnosis.22 recent findings
Integrated treatment for co-occurring disorders means that the treatment you receive is designed to be individualized, holistic, and comprehensive so it can address both mental illness and addiction. It typically involves a combination of behavioral therapies and medication, such as:23 how are they diagnosed and treated
- CBT, which helps you identify and change negative thoughts and behaviors.
- Dialectical behavior therapy (DBT), which focuses on reducing self-harm.
- Assertive community treatment (ACT), which involves community outreach and individualized treatment plans.
- Therapeutic communities (TCs), which are substance-free residences to help people re-socialize into the community.
- Contingency management (CM), which provides positive reinforcement (like vouchers) for healthy behaviors and changes.
- Medication, which can vary depending on the substance you abuse. The NIDA points out that most medications have not been well-studied in people with co-occurring disorders, so more research is needed to fully evaluate the effects and benefits.
Do I Need Integrated Treatment?
If you have been diagnosed with bipolar disorder (or another psychiatric disorder) and are struggling with substance abuse, then it’s likely that you’ll benefit from integrated treatment. It’s advisable to consult your doctor or a treatment center before deciding on a particular plan, so you can discuss your specific concerns and evaluate your individual needs.