Bipolar Disorder and Substance Abuse

Studies reveal that more than 50 percent of all bipolar disorder sufferers will struggle with alcohol and/or drug abuse at some point in their lives. Among individuals diagnosed with bipolar I, the most severe form of the disorder, the lifetime incidence of substance abuse is more than 60 percent.

In total, about eight million out of the 21 million Americans who abuse alcohol or drugs each year will also suffer from at least one mental health disorder. This puts a tremendous diagnostic burden on physicians and mental health professionals, who must untangle the symptoms of multiple emotional and behavioral health issues to accurately detect their presence.

Substance use disorders aren’t the only condition that occur in tandem with bipolar disorder, but they are easily the most common source of a dual diagnosis in bipolar patients.

Like other mood disorders, bipolar disorder causes emotional and behavioral changes that can be painful and disturbing.

Bipolar depression is essentially the same as clinical depression, with a profile of symptoms that leaves sufferers feeling empty of emotion and motivation. Bipolar mania is generally not as debilitating as bipolar depression, but it still means a loss of control, as bipolar sufferers experiencing a manic episode are unable to slow down or rest. In extreme cases they may require hospitalization and crisis intervention.

Caught up by forces they don’t completely understand, individuals with bipolar disorder are constantly searching for ways to control, suppress, or overcome their unwanted highs and lows. A return to emotional equilibrium is what they seek, and many turn to drugs and/or alcohol in their desperate attempts to balance or eliminate unpleasant moods.

It is often suggested that people with mental health issues use drugs and alcohol to self-medicate. When bipolar has yet to be diagnosed and bipolar medication has not been prescribed, the temptation to consume other substances that affect mood is undoubtedly strong for many people, especially if they’ve already been introduced to drugs or alcohol in another context.

Since 86 percent of adults age 18 and older (and a majority of adolescents) have tried alcohol at some point in their lives, most people who experience bipolar symptoms will, in fact, be familiar with alcohol’s mood-altering effects. Levels of illicit drug use are not as high, but according to the Substance Abuse and Mental Health Services Administration (SAMHSA), as many as 130 million Americans above the age of 12 have at least experimented with illegal substances. So here, as well, familiarity with these substances is common.

Because intoxicants do affect mood, it is not surprising that many bipolar sufferers turn to drugs and alcohol to overcome feelings they find troublesome, disabling, or frightening. Bipolar depression symptoms in particular are highly upsetting and can leave sufferers desperate to find an escape.

But the attempt to self-medicate for bipolar symptoms is ultimately futile. Temporary boosts in mood are possible, but no one gets lasting relief from mental illness through drugs and alcohol. Chemical dependency gradually develops as tolerance for intoxicants grows, and those who compulsively drink or abuse drugs in response to bipolar symptoms are inevitably headed for a fall.

The self-medication hypothesis clearly has merit, and virtually all mental health experts subscribe to it. But the connection between bipolar and substance abuse is too complex to be reduced to only one explanation.

Because alcohol and drug consumption are so common, the relationship between substance use disorder and bipolar disorder may be coincidental in some cases. In other words, the bipolar disorder and the substance use disorder might develop separately but in parallel, since people from all walks of life and all backgrounds can and do encounter chemical dependency issues. There is an inherent risk for substance use disorder whenever anyone experiments with drugs and alcohol, regardless of their reasons for doing so.

At least in some cases, the substance use disorder might actually begin to develop before bipolar disorder symptoms manifest. This does not mean the substance abuse caused the bipolar, but it does raise the possibility that some people might be vulnerable to both conditions based on genetic or neurological factors, with efforts to self-medicate having no role to play in the onset of substance use disorder. There is also evidence to suggest that exposure to trauma in childhood might predispose a person to mental health problems and substance use disorders later in life, although genetic vulnerabilities may still play a causative role.

In the end, cause-and-effect relationships between substance use disorders and bipolar are incidental to the need to treat both conditions when they arise. It would be wise for individuals with bipolar disorder to avoid drugs and alcohol at all costs, since the possibility of substance use disorder is very real if they follow that path. But once chemical dependency has developed, it is a serious complicating factor that must be addressed.

When co-occurring disorders are present, symptoms caused by one may make it more difficult to diagnose the other. This tends to be a big problem with bipolar disorder, which is a complex condition that can easily be mistaken for another disorder in its early stages (and sometimes even beyond).

Since mood swings are a common side effect of drugs and alcohol, their consumption can certainly mask bipolar symptoms to some extent. In general, drug and alcohol abuse has such a powerful impact on a person’s life that it will tend to overshadow any other emotional or behavioral health conditions that might be present.

In addition to its effect on the ability of mental health professionals to make an accurate diagnosis, the simultaneous existence of bipolar and substance abuse is problematic in other ways. When consumed to excess by individuals with bipolar disorder, drugs and alcohol can cause:

• More intense manic symptoms (increased irritability, poorer memory and concentration, diminished judgment, more risky and dangerous behavior, etc.)
• A deepening of bipolar depression after the initial effects of the drugs and alcohol wear off
• Greater difficulties in handling daily responsibilities (parental, job, financial, relationship, etc.)
• More emotional instability
• More accidents and injuries
• An increased number of suicide attempts

The combination of bipolar disorder and alcohol abuse, or bipolar and drug abuse, can quickly send anyone on a downward spiral from which it may be difficult to recover.

Unless a bipolar diagnosis is made, and the presence of the substance use disorder detected, an individual suffering from these co-occurring disorders could be headed for tragedy.

Mental health professionals in diagnostic mode are trained to look out for multiple mental, emotional, and behavioral health issues. When the symptoms of bipolar disorder and a substance use disorder are each present, and reported accurately and completely by patients and their family members, a dual diagnosis for both conditions can usually be made, and at that point treatment can begin.

In these situations, bipolar disorder and substance abuse must be treated concurrently and comprehensively. Both are an equal priority for treatment professionals, who will provide initial services through mental health and substance use disorder treatment centers that offer programs for co-occurring disorders. Residential treatment is absolutely essential when bipolar and substance abuse have both been diagnosed together, and in some instances mental health rehab may need to continue for longer than the usual 30- to 90-day period.

Integrated treatment services for co-occurring bipolar disorder and substance abuse are designed to address each symptom of both disorders in a systematic way. Teams of substance use disorder treatment and mental health experts will work with their patients on a daily basis, helping them understand all the challenges they face as they develop strategies to manage their bipolar symptoms and maintain their sobriety.

Bipolar medication, including mood stabilizers, antidepressants and/or antipsychotic drugs, will be administered to help patients control their bipolar disorder symptoms. When drug or alcohol use is severe, drugs that help those with chemical dependency handle cravings or withdrawal symptoms may be prescribed as well. Other treatments offered will include individual, group and family therapy, life skills and educational classes, and holistic mind-body healing practices that will show men and women in recovery how to manage stress and improve mood.

The goal of integrated, inpatient treatment for bipolar disorder and substance abuse is to put those with a dual diagnosis on a path to full and sustainable wellness. Their substance use disorder recovery process will continue in outpatient and aftercare treatment programs, where counseling sessions and peer group support meetings will help reinforce their commitment to sobriety. Meanwhile, outpatient therapy for their mental health issues will also be offered, and they will need to continue taking their bipolar medication to preserve their newfound emotional equilibrium.

It is critical that individuals taking these pharmaceutical medicines avoid illicit drugs and alcohol at all costs. This combination can cause dangerous side effects and can make it impossible for a person to maintain their regular bipolar medication schedule.

Individuals with a dual diagnosis for bipolar disorder and alcohol or drug abuse do face some significant life challenges. But with a patient, consistent, and dedicated approach to recovery, plus the assistance of mental health and other medical professionals with expertise in treating co-occurring conditions, they can eventually overcome their disorders and return to living happily, freely, and without scary bipolar symptoms that might tempt them to return to drugs and alcohol.

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