Bipolar disorder and addiction

DEFINITION: Bipolar disorder is a chronic mental health condition characterized by cycles of depression and mania. This condition, earlier known as manic-depressive disorder, affects nearly 10 million American adults. Persons living with bipolar disorder are at high risk of substance use disorders and suicide. This condition has a high rate of recurrence and, if untreated, has up to a 20 percent risk of death by suicide.

Background

The coexistence of bipolar disorder and substance use disorders (SUD) is the rule rather than the exception. As many as 65 percent of people with bipolar disorder also develop a SUD at some point, and 54 percent develop alcohol use disorder during their lifetime, according to the American Addiction Centers.

A person experiencing the manic phase of bipolar disorder may use alcohol or drugs to try to stabilize their condition. An addiction to alcohol or drugs might come about because the person is trying to slow down their thought processes long enough to get some rest. Addiction may be the result of, and not the reason for, the manic phase of the illness.

In the depressive stage, a person is vulnerable to addiction because they are looking for something that will help with feelings of hopelessness, isolation, and worthlessness. Alcohol or drugs may be considered a type of anesthetic to help the person escape from these feelings.

Causes

Persons living with bipolar disorder are subject to overwhelming forces that are largely beyond their conscious control, leading many people to rely on drugs and alcohol for support and relief. Often, people with bipolar disorder use alcohol or drugs to numb their symptoms and to help them cope with their intense feelings. This can lead to a pattern of abuse that can quickly spiral into dependency and addiction.

People living with bipolar disorder are more likely than others to abuse alcohol or drugs, such as sleeping pills and stimulants (including cocaine and methamphetamines). Drugs and alcohol are abused to increase the natural high of mania and to self-medicate during depressive episodes.

Symptoms

Bipolar disorder is characterized by drastic mood swings—extreme highs and devastating lows. Some of the symptoms exhibited during manic episodes include an extremely elated, happy mood or an extremely irritable, angry, unpleasant mood; increased physical and mental activity and energy; racing and uncontrolled thoughts; increased talking (speech more rapid than normal); ambitious, often grandiose plans; inflated self-esteem; risk taking; and impulsive activity such as spending sprees; risky sexual behavior; and decreased sleep without experiencing fatigue.

Symptoms of depressive episodes include loss of energy; prolonged sadness; decreased energy and activity; restlessness and irritability; inability to concentrate or make decisions; increased worry and anxiety; less interest or participation in, and less enjoyment of, activities normally enjoyed; feelings of guilt and hopelessness; change in appetite; change in sleep patterns; and thoughts of suicide.

People with bipolar disorder may have difficulty in the workplace. Many of their symptoms can interfere with their ability to show up for work, perform their duties, and interact productively with others.

The consequences of addiction for persons living with bipolar disorder include taking drugs or consuming alcohol to regulate, stabilize, or improve their mood. Drugs and alcohol can provide temporary symptom relief, but in time, they worsen the symptoms, resulting in ever-increasing drug or alcohol use. Alcohol and drugs can reduce the effectiveness of bipolar medications and reduce compliance with bipolar treatment. Stimulant drugs, such as cocaine or methamphetamines, can induce mania followed by deep depression, exacerbating symptoms. Withdrawal symptoms can worsen depression.

Screening and Diagnosis

A diagnosis of substance use disorder in persons living with bipolar disorder is known as a dual diagnosis. In such cases, the substance use can occur during both the manic and the depressive phases.

No diagnostic laboratory tests exist for bipolar disorder. Thus, diagnosis is based on standardized diagnostic criteria to rate and evaluate the person’s behavior. Medical professionals may interview the individual and their family members, or use tools such as mood charts or standardized diagnostic assessments. These assessments may include the Addiction Severity Index, the Structured Clinical Interview for DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), the Alcohol Use Disorder Identification Test, or the Young Mania Rating Scale.

Treatment and Therapy

Treatment for addiction includes psychiatric care and medication. Because bipolar disorder and alcohol and drug addiction often appear together, the symptoms of each disorder overlap, making it difficult to recognize the coexistence of both. The two conditions must be treated in tandem, making dual diagnosis critical to the recovery process.

An effective residential substance abuse treatment program is used to treat co-occurring disorders. This treatment typically includes individual and group counseling, cognitive-behavior therapy, dialectical behavior therapy, twelve-step programs, and other mental health services. Research has shown that the most effective treatment combines supportive psychotherapy and the use of a mood-stabilizer (lithium, carbamazepine, or divalproex/valproic acid), often with an antipsychotic medication. However, psychotherapy is not an effective substitute for medication.

Prevention

The best recoveries are achieved when individuals with bipolar disorder get effective treatment and consistently follow treatment recommendations for a lifetime. The patient should regularly see a supportive physician who is knowledgeable about the psychiatric management of this condition, should learn what symptoms predict the return of this illness and what additional “rescue” medication can be taken, and should learn to trust the warnings given by family and friends when they see early signs of relapse.

Bibliography

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