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Bipolar Disorder and Addiction

bipolar disorder and addiction treatment

Bipolar disorder, historically referred to as “manic depression,” is a serious mental health condition that causes radical shifts in mood and energy. Those who are affected by bipolar disorder often fight to live their life normally, as the bouts of depression (that follow or precede surges of energy) are debilitating. Those with bipolar disorder may stay in bed for weeks at a time before getting the strength to go to work, clean the house, meet with friends, or even eat a complete meal.

People with bipolar disorder are more likely to experience relationship problems, financial instability, accidental injury, and suicide than the general population. They are also significantly more likely to abuse drugs and alcohol.

Today, about 2.8 percent of the U.S. adult population – or, nine million Americans – battle bipolar disorder. Of these millions, close to 60 percent also have a history of substance abuse.

Addiction and bipolar disorder are both chronic disorders of the brain – affecting how a person feels, behaves, and acts day-to-day. When the disorders co-occur, it can make treatment and recovery more difficult. If you have a loved one whose battling bipolar disorder and substance abuse, it is important to seek professional care. Untreated substance use and bipolar disorders can significantly increase a person’s risk for suicide and impair their quality of life.

Understanding Bipolar Disorder and Addiction

As noted above, people with bipolar disorder experience intense mood swings, or “highs” and “lows” in energy. The “lows” are called “episodes,” which can last for days or weeks at a time. They may occur often – several times per week – or just a couple times per year. There are four types of clinical episodes associated with bipolar disorder:

  • Manic Episodes – The person is excessively cheerful or hostile. Manic episodes will last a week or longer, and may require hospitalization.
  • Hypomanic Episodes – The person is excessively cheerful or hostile, but the manic symptoms only last a few (at least four) days. These episodes are therefore shorter and less severe.
  • Major Depressive Episodes ­– The person is depressed and uninterested in any activity. This must last at least two weeks to meet the clinical definition of a major depressive episode.
  • Mixed Episodes – The person is experiencing a mix of manic, hypomanic, and depressive episodes. For example, their body may show a hyperactive state, while their mind is experiencing feelings of depression.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) defines bipolar disorder in two categories. The first is bipolar I disorder, in which a person must have had one or more manic episode, lasting at least a week at a time. Those with bipolar I disorder may experience depression, but a major depressive episode is not necessary for this diagnosis. The second category is bipolar II disorder, which is characterized by at least one hypomanic episode (lasting at least 4 days) along with a major depressive episode that lasts at least 2 weeks.

While many will say that bipolar I disorder is more severe than bipolar II, neither is more severe than the other. The major depressive episodes associated with bipolar II disorder can be just as disabling as the manic episodes associated with bipolar I.

The Link Between Bipolar Disorder and Addiction

National research shows that co-occurring substance use disorders are most common among people battling bipolar disorder, versus any other mental illness. In fact, between 30 and 60 percent of people with bipolar disorder will develop a substance use disorder (SUD) during their lifetime.

Why are they commonly connected? In some cases, people with bipolar disorder may turn to drugs and alcohol during periods of impaired judgement and mania. Or, they may turn to substances to alleviate their symptoms. This is called self-medication. In other words, bipolar individuals will reach for a bottle – of alcohol, or pills – to try and ease the pain of their disease. This may be an effort to cope with bouts of depression or anxiety. Or, it may be an effort to stabilize the mania and restlessness.

While there may be some temporary relief from drug and alcohol use, this coping mechanism does not work long-term. Research tells us that substance abuse actually exacerbates the symptoms of bipolar disorder, and can trigger worsened depressive and manic moods. In fact, some researchers believe that substance abuse can also cause bipolar disorder to surface in individuals with no history of mental health issues. 

Both bipolar and substance use disorders affect the same systems of the brain – the ones that regulate impulsivity, motivation, stress response, and reward. The disorders – separate, or co-occurring – also disrupt the same chemicals within the brain. Bipolar individuals have abnormal levels of serotonin, dopamine, and norepinephrine, affecting their sleeping, eating, stress and mood patterns. Similarly, heavy use of drugs or alcohol can disrupt how the brain processes serotonin, dopamine, and norepinephrine—causing emotional instability, erratic energy levels, and depressive symptoms.

Co-Occurring Bipolar Disorder and Addiction Treatment

According to the Substance Abuse and Mental Health Administration (SAMHSA), “Only a behavioral health professional who is licensed to diagnose and treat mental disorders should provide treatment for bipolar disorder. Treatment can be complex and is often individualized according to a patient’s symptoms, needs, preferences, and responses to treatment.”

When substance abuse co-occurs with bipolar disorder, this makes treatment even more difficult. This is due to the overlapping nature of these diseases within the brain. In order for each disorder to be treated effectively, they must be treated in an integrated manner – at the same time and same place, in which both disorders and their symptoms are considered together, by a single team of clinicians. This is called integrated dual diagnosis treatment, which involves treatment of the “whole person.”

In an integrated setting, your loved one will receive a multi-dimensional treatment plan that is individualized to his or her needs. A dual diagnosis treatment center will be equipped to help your loved one get to the root of their substance abuse, while effectively managing the difficult symptoms of bipolar disorder. This may involve both psychosocial and pharmacological therapies. In Turnbridge’s bipolar disorder and addiction treatment programs, for example, clients participate in:

  • Cognitive behavioral therapy (CBT)
  • 12-step programs
  • Individual counseling
  • Integrated group therapy
  • Family-focused therapy

Be sure to seek a program that is well-versed in dual diagnosis, that offers an integrated treatment model, and that will customize a treatment plan based on your loved one’s needs. Without integrated treatment, there is a greater risk of relapse of both illnesses.

A Note on Bipolar Disorder and Addiction in Youth

Early intervention can greatly improve treatment outcomes for individuals with co-occurring SUDs and bipolar disorder, according to SAMHSA. This is especially true for adolescents and young adults, whose brains are still developing.

The median age of onset for bipolar disorder is about 25 years old, but the illness can start as early as childhood. It is before this age that most people will try drugs and alcohol.

Adolescents and young adults battling symptoms of depression are more likely to try drugs or drink at a young age. They are also more likely to be diagnosed with bipolar disorder down the road. According to the American Academy of Child and Adolescent Psychiatry, if your child is showing signs of depression, he or she may actually be experiencing an early onset of bipolar disorder. It is estimated that up to one-third of children with bipolar disorder are misdiagnosed with depression.

As a result, early intervention can be critical for adolescents and young adults battling substance abuse and depression , or substance abuse and bipolar disorder. To learn about Turnbridge’s dual diagnosis programs – designed specifically for youth with co-occurring mental health disorders – please do not hesitate to call 877-581-1793.