Bipolar disorder is a mental health condition characterized by extreme mood swings that can negatively affect a person’s daily functioning, relationships, and quality of life. Living with bipolar disorder alone is difficult enough, but many people with the condition also suffer from a co-occurring drug or alcohol addiction. When bipolar occurs alongside substance use disorder, symptoms can worsen, and it can be more difficult to find and maintain effective treatment plans.  

Understanding the intricate relationship between bipolar disorder and substance abuse is crucial for effective diagnosis, treatment, and support.

What is Bipolar Disorder?

Bipolar disorder is a mental illness that causes extreme changes in a person’s mood and energy levels. These changes range from abnormally elevated mood (mania and hypomania) to abnormally low mood (depression). Individuals who have four or more manic or depressive episodes in a year are diagnosed with rapid cycling bipolar disorder.

Bipolar disorder is separated into three categories or subtypes: 

• Bipolar I: People with Bipolar I experience manic episodes that last at least seven days or are so severe that they may require hospitalization. These manic episodes may or may not be followed by an episode of depression.
• Bipolar II: People with Bipolar II experience both depressive and hypomanic episodes. Their mania is less severe than those with Bipolar II, but they still experience the cyclical extreme moods indicative of bipolar disorder.
• Cyclothymic disorder: People with cyclothymic disorder experience both hypomanic and depressive episodes, but they are not intense or long-lasting enough to meet the criteria for full depressive or hypomanic episodes.

What is Substance Use Disorder (SUD)?

Substance use disorders are chronic diseases that cause a physical, emotional, or psychological dependence on drugs or alcohol. People with SUDs engage in recurrent substance use, despite persistent harmful effects on their health, relationships, or functioning. 

Signs of a substance use disorder include:

• Powerful, persistent urges to use a substance
• Intense desire to stop using a substance but feeling incapable of stopping
• Continuing substance use even when dangerous health problems occur or are likely to occur
• Continuing to use substances despite it causing problems in personal relationships
• Prioritizing substance use over work, family, or personal responsibilities
• Needing to use larger amounts of a substance to achieve desired effects

SUDs occur on a spectrum, ranging from mild to severe. The longer a person abuses substances, the more likely they are to experience severe withdrawal symptoms when they try to quit using. For people with severe drug or alcohol addictions, withdrawal can be dangerous or even life-threatening without medical supervision and support. 

Critically, substance use disorders can be managed with the right treatment program and support system. A combination of rehab, ongoing therapy, recovery support groups, and certain medications can help people with SUD manage their addictions and maintain sobriety. 

The Intersection of Bipolar Disorder and Substance Abuse

Co-occurring disorders refer to the simultaneous presence of a substance use disorder and a mental health disorder. Someone who experiences both bipolar disorder and substance use disorder has what is known as a dual diagnosis. Research shows a consistent overlap between bipolar disorder and substance use disorders.

Individuals with bipolar disorder often begin abusing substances as a way to self-medicate their intense mood swings. Over time, they may develop a dependency that drives continued or increased substance use, even when it makes their bipolar symptoms worse. 

This interplay is an example of a common and dangerous cycle for people with both SUD and mental illness; substance use exacerbates the symptoms of many mental health disorders and often interferes with the efficacy of prescribed medications. However, it’s often the symptoms of mental illness that motivate a person’s substance use in the first place. In this cycle, SUD makes mental illness worse and vice versa. 

Substance Use in People with Bipolar Disorder

The intense mood swings of bipolar disorder can often feel overwhelming, and substances such as alcohol or drugs may provide temporary relief. During manic episodes, individuals might turn to substances to curb their heightened energy levels or to cope with impulsivity. Conversely, substances may be used during depressive episodes to escape feelings of lethargy, despair, and emotional pain.

However, relying on substances as a coping mechanism for bipolar disorder is a double-edged sword. While they may temporarily alleviate symptoms, they can worsen the severity and frequency of bipolar mood swings over time. This destructive cycle makes it challenging for individuals to manage either their bipolar disorder or their worsening substance abuse issues.

Risk Factors for Co-Occurring SUD with Bipolar Disorder

Several risk factors contribute to the high prevalence of co-occurring bipolar disorder and substance abuse:

• Genetic predisposition: People with a family history of bipolar disorder or substance use disorder are more likely to develop one or both conditions
• Environmental factors: Traumatic experiences and ongoing stress are linked to a higher likelihood of mental illness and/or substance use disorder
• Neurological imbalances 

Additionally, certain substances are more commonly abused by individuals with bipolar disorder. Alcohol, cannabis, cocaine, and stimulants are frequently reported substances of choice, but each is known to exacerbate the challenges of managing bipolar symptoms.

The neurobiological connection between bipolar disorder and addiction is complex and not fully understood. Both conditions involve dysregulation of neurotransmitters, such as dopamine and serotonin, further complicating the relationship. Ongoing research seeks to unravel the intricate interplay between the brain’s reward system, mood regulation, and the impact of substances on individuals with bipolar disorder.

Prevention and Intervention Strategies

Early detection, education, and intervention can help prevent the development of co-occurring drug or alcohol addiction in people with bipolar disorder. Mental health screenings should be a routine part of healthcare assessments, especially for individuals exhibiting mood instability or other symptoms indicative of bipolar disorder. Education on the risks associated with substance abuse and the potential impact on bipolar disorder can empower individuals to make informed decisions about their health.

Intervention strategies should be tailored to both the mental health and substance abuse aspects of an individual’s condition. Psychotherapy, counseling, and support groups can be instrumental in helping individuals develop healthier coping mechanisms for their symptoms. Family and social support also play a crucial role in the long-term recovery process.

Treatment for Co-Occurring Bipolar and Addiction

The presence of co-occurring substance abuse complicates the treatment of bipolar disorder. Substance use can interfere with the effectiveness of medications prescribed for bipolar disorder, leading to treatment resistance and increased relapse rates. Moreover, substance abuse can mask or mimic the symptoms of bipolar disorder, making it difficult for healthcare professionals to diagnose and treat both conditions accurately.

Integrated treatment approaches that concurrently address both bipolar disorder and substance abuse have shown promising outcomes. However, it requires a collaborative effort between mental health professionals, addiction specialists, and the individual seeking treatment. Dual-diagnosis treatment programs aim to break the cycle of self-medication with illicit and damaging substances and to provide comprehensive care for both bipolar disorder and substance use disorder.

Finding Help for Co-Occurring Bipolar Disorder and SUD

It is critical for people with a dual diagnosis to seek treatment programs that understand and address the interplay between their bipolar disorder symptoms and their drug or alcohol addiction.

Dual-diagnosis treatment centers provide simultaneous treatment and therapy for both mental illness and substance abuse issues, helping individuals overcome the root causes and complexities of both. 

Silver Pines Treatment Center knows how difficult it is to overcome either condition independently. We take an evidence-based, personalized approach to addressing co-occurring conditions so each of our clients has the best chance at lasting healing and recovery. 

Are you or a loved one struggling with bipolar disorder and substance abuse issues? We are here to help. Reach out to us by phone at 267-719-8689 or submit an online contact form. You can speak with an admissions specialist who will outline your options and help you find the treatment program best suited for your needs. You never have to handle your mental health on your own again; Silver Pines Treatment is here for you and your family.

References

1. National Institute of Mental Health. (2023). Bipolar Disorder.
2. National Institute on Drug Abuse. (2020). Drug Misuse and Addiction.
3. National Institute of Mental Health. (2023). Substance Use and Co-Occurring Mental Disorders.