Addiction and Bipolar Disorder
Many people with bipolar disorder also struggle with a co-occurring substance abuse disorder, sometimes as a means of self-medication or as a coping mechanism. People with mood disorders often feel an intense desire to escape the overwhelming pain they are feeling. But intensive treatment for both disorders can reduce symptoms and help people who are suffering from addiction and bipolar disorder live productive lives.
What Is Addiction and Bipolar Disorder?
Bipolar disorder is a condition that affects the brain and causes extreme shifts in mood. All forms of bipolar disorder heighten the risk of developing a substance use disorder for a number of complex and oven overlapping reasons. Like all people who experience mental health disorders, people with bipolar disorder may seek emotional refuge in drugs and/or alcohol as a way of coping with distress, protecting themselves against disturbing thoughts and feelings, or ostensibly improving function. In some cases, alcohol or drug use includes the use of prescription medications, such as benzodiazepines, which are sometimes prescribed to ease bipolar symptoms. However, substance use can severely worsen symptoms of bipolar disorder, setting off a cycle of suffering and use that is difficult to break without professional intervention.
Simultaneously, the lowered inhibitions and increased risk-taking experienced by many during manic, hypomanic, or mixed episodes decrease the ability or desire to self-regulate or engage in risk-reducing behaviors. As such, a person with bipolar disorder may be willing to try drugs, consume more drugs or alcohol at higher quantities, and take them with greater frequency than they would otherwise. This can either initiate or aggravate an addiction.
Symptoms and Diagnosis of Bipolar Disorder
Bipolar disorder can be very difficult to diagnose, because the symptoms are similar to other mental health conditions. Many times, people with bipolar disorder are misdiagnosed with schizophrenia, anxiety disorders, depression, or substance abuse problems.
According to the Diagnostic and Statistical Manual of Mental Health (DSM-5), to be diagnosed with bipolar disorder several requirements must be met based on the type of bipolar disorder suspected. Additionally, diagnosis depends on moods shifts between various phases of the condition, whether it is characterized by mania, hypomania, or depression.
Mental health professionals trying to decide if bipolar disorder is present will generally consider the mood presented during the visit—depressive, manic, or hypomania—and whether there is a history of mood swings to other symptoms. For example, if a person presents with a manic mood, inquiry is made into whether there is a history of swings to hypomania, or depressive moods. Professionals also conduct a detailed medical and family history, as well as consult the DSM-5 to see if symptoms meet the established criteria for bipolar disorder.
Symptoms of the disorder depend on the type of bipolar episode is experienced.
Types of Bipolar Disorder
Bipolar disorder is a mental health illness that includes three separate conditions: bipolar I, bipolar II, and cyclothymic disorder.
- Bipolar I is generally characterized by episodes of mania followed by episodes of major depression. Episodes of mania often last about seven days or are so severe they require emergency medical treatment. Depressive episodes last about two weeks. It is also possible for episodes of mania and depression to occur together.
- Bipolar II is different from bipolar I. People suffering from bipolar II tend to cycle episodes of hypomania and depression but do not experience full-blown mania.
- Cyclothymic disorder is described as having multiple episodes of hypomanic and depressive symptoms that last for at least two years. The symptoms are milder and tend not to meet the DSM-5 requirements for either hypomanic or depressive episodes.
Although those who suffer from bipolar disorder also experience moods that are typical of most people, they often experience moods far more intensely and across a broader scale. Moods associated with bipolar disorder are generally categorized as manic, hypomanic, or depressive.
Manic mood episodes are described as having an extremely elevated, energized or agitated mood, most days, for most of the day, over at least a week. Additionally, a person suffering from mania must experience three of the following symptoms, which also represent a significant and observable change in behavior:
- Excessive talking, loud and quick talking
- Racing thoughts, or ideas that change rapidly and are uncontrollable
- Taking on more tasks or events in one day that can be completed, or engaging in multiple activities at once
- Being unfocused and easily distracted
- Sleeping less, or needing less sleep
- Increase in risk taking and risky behavior
- Delusions of grandeur or inflated sense of self
Symptoms of mania often interfere with daily functioning and may cause emergency medical intervention.
Hypomanic mood episodes are very similar to manic episodes. However, they are less severe, tend to only last for about four days, and generally do not interfere with the ability to carry out the responsibilities of daily life.
Depressive mood episodes are similar to major depressive disorder. Symptoms last most days, for most of the day, over a two-week period, and include feelings of extreme sadness or hopelessness and a loss of interest in activities once enjoyed. At least three of the following additional symptoms must also be experienced:
- Feelings of guilt of worthlessness
- Trouble falling asleep or staying asleep, or sleeping too much
- Fatigue and energy loss
- Restlessness, agitation, and/or slowed movements or speech
- Problems with memory, concentration, or decision making
- Unexplained increase, or decrease, in appetite
- Excessive thoughts of death or suicidal ideations
Facts and Statistics
- According to the National Institute of Mental Health (NIMH), just under 6 million Americans suffered from bipolar disorder in 2015. About 89 percent of that number also suffered major impairment, and 17.9 percent experienced moderate impairment of function in daily life.
- In 2016, about 20 million people had a substance abuse problem. That same year, almost 9 million people suffered from both a mental health illness and a substance abuse problem.
- People who have bipolar disorder tend to be at greater risk for substance abuse disorder and vice versa. In fact, between 30 and 60 percent of people who suffer from bipolar disorder also abuse drugs and alcohol.
- People who were mentally healthy prior to substance abuse can develop bipolar disorder after long-term, chronic use of drugs or alcohol. Changes in brain chemistry can lead to mood and emotional dysregulation.
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Bipolar Disorder and Substance Abuse
People with bipolar disorder tend to have other co-occurring mental health conditions, such as anxiety, psychosis, and other mood disorders.
People who suffer from bipolar disorder also often suffer from addiction. People with bipolar disorder typically turn to drugs and alcohol to alleviate symptoms and regulate mood. Suffering from the two disorders together tends to intensify symptoms, increase the duration of episodes, and increase the risk of negative outcomes. It also complicates treatment.
Co-occurring bipolar disorder and substance abuse require specialized treatment provided by medical and mental health professionals to treat both problems. Residential care can be essential in treating both co-occurring disorders in a safe, controlled environment.
Withdrawal and Detox
Prescription medications used to treat bipolar disorder can negatively interact with drugs or alcohol. Mixing drugs or alcohol with bipolar medications can also be deadly. Before beginning treatment for bipolar disorder, a person who is using or addicted to other substances must stop use to avoid pharmaceutical contraindications.
However, addiction to drugs or alcohol can lead to withdrawal if use of the drugs or alcohol is suddenly stopped. Physiological and psychological changes tend to occur as the person experiences symptoms of withdrawal. When bipolar disorder is also present, symptoms of the condition may also intensify. For instance, hypomania could turn into a full manic episode.
Generally, withdrawal from drugs or alcohol should be monitored by a medical professional, in an inpatient setting, to avoid additional serious medical conditions or emergencies.
Overdose and Bipolar Disorder
When a person is addicted to drugs or alcohol, the risk of overdose tends to increase. The risk is even higher when a mental health condition, like bipolar disorder, is also a factor. Part of the reason is that drugs and alcohol often intensify symptoms of bipolar disorder when the drug or alcohol wears off, which in turn can increase the need for relief from those symptoms through further drug use.
Additionally, use of alcohol or illicit substances can cause overdose or even death when mixed with medications used to treat bipolar disorder. Per the Centers for Disease Control, drug overdose is the leading cause of accidental death in America.
If overdose is suspected, it is essential to seek immediate emergency medical attention.
Bipolar Disorder and Addiction Treatment and Prognosis
With intensive treatment at a residential treatment facility, many people who suffer from bipolar disorder are generally able to better manage mood, emotions, and other symptoms. Effective treatment programs usually integrate intensive individualized plans, psychotherapy, and medications.
Although treatment is effective for many people, bipolar disorder is a chronic condition that tends to last a lifetime. Episodes of experiencing symptoms often re-occur. However, treatment can provide longer periods between episodes, less intense episodes, and even symptom-free periods of time. Continual long-term treatment can improve the ability of people with bipolar disorder to function daily and lead a successful and productive life.
People who suffer from addiction usually are treated for both their addiction and co-occurring disorder at the same time. Many of the treatment protocols, such as psychotherapy, overlap.
Relapse prevention can be an important piece of a treatment plan for people with bipolar disorder who also struggle with addiction. Relapse prevention plans are designed to maintain sobriety after treatment for addiction has ended. Ongoing help through a dedicated support network can help people transition back into their lives more effectively and continue improving or eliminating their symptoms.