What’s The Link Between Bipolar Disorder And Addiction?

Many people with anaddiction have aco-existing mental health condition, such as bipolar disorder. Bipolar disorder is a mood disorder that is characterized by experiencingdepression and mania, commonly referred to as “mood swings.”

People with bipolar disorder may usedrugs andalcohol to cope with intense mood swings,anxiety, mania, and depression, as these symptoms can be incredibly distressing. Likewise, drugs and alcohol can worsen symptoms of bipolar disorder, creating a vicious cycle where addiction fuels bipolar disorder and vice versa. Additionally, bipolar disorder and addiction often share common underlyinggenetic and neurobiological factors.

Understanding Bipolar Disorder

Bipolar disorder, formally known as bipolar affective disorder, is a mood disorder characterized by mood swings, changes in energy levels, alternating thought patterns, and sleep disturbance. It is often identified by the presence of depressive and manic episodes; however, it is a common misconception that these alternating mood swings are the sole marker of bipolar disorder.

Additional causes for bipolar disorder include:

• Genetics
• Imbalanced chemicals in the brain
• Traumatic environment and experiences

Bipolar disorder is a punctuated disorder, meaning that many individuals act and feel completely normal between their depressive and manic episodes, which may happen as often as several times a week or as little as a few times a year.

When these episodes do occur, they can last for days or weeks at a time, and people may turn to drugs or alcohol to try to minimize symptoms associated with the episodes. Bipolar disorder also causes major changes in energy and concentration.

There are four types of episodes people with bipolar disorder may experience. These include:

Manic Episodes

During a manic episode, someone with bipolar disorder may be excessively cheerful or hostile. These episodes last a week or more and may require hospitalization.

Hypomanic Episodes

There are only subtle differences between hypomanic and manic episodes. The main difference is that hypomanic episodes are shorter, lasting at least 4 days, and are less severe.

Major Depressive Episodes

These episodes leave people feeling depressed and uninterested in activities. A person’s depressed mood has to last at least 2 weeks to meet the clinical definition of an episode.

Mixed Features 

Some people with bipolar disorder have mixed episodes. These episodes include traits of manic, hypomanic, and major depressive episodes

TheDiagnostic and Statistical Manual of Mental Disorders (DSM-5) provides two categories for bipolar disorder: bipolar I and bipolar II.

Bipolar I Vs Bipolar II

People with bipolar I experience full manic episodes, while people with bipolar II have significant depressive episodes with hypomanic episodes. Both bipolar I and bipolar II can have mixed features, but bipolar I is often considered more severe than bipolar II due to the presence of the manic episodes.

Can Substance Abuse Cause Bipolar Disorder?

It is possible for substance misuse to be the cause of a person’s bipolar symptoms. This condition is called substance-induced mood disorder and is characterized by depressive, psychotic, or manic symptoms that occur as a physiological consequence of substance or medication misuse.

Since substance-induced mood disorders are directly caused by substance abuse or withdrawal, bipolar symptoms will resolve during abstinence, since the substance-induced bipolar disorder was only driven by drugs and alcohol.

This differs from a co-occurring disorder, which involves two separate conditions, such as bipolar disorder and addiction, that develop independently but exist together and influence each other. Often, one can make the other worse. If a person has a bipolar disorder and a co-occurring addiction, if the person remained fully abstinent and adhered to their recovery program, their bipolar disorder would still exist.

Symptoms And Effects Of Bipolar Disorder

The symptoms of bipolar disorder are marked by a spectrum of depressive and manic symptoms, and those who have a co-occurring addiction usually have heightened bipolar symptoms due to substance use. Bipolar disorder symptoms are generally broken down into manic episode symptoms and depressive episode symptoms.

Manic Episode Symptoms

• Hyperactivity
• Inflated sense of self-confidence
• Decreased need for sleep
• Extreme talkativeness
• Racing thoughts
• Short attention span
• Risky behavior
• Preoccupation with a specific goal

Some people experience manic episodes so severe that they are unable to function in a social or occupational setting. People having these episodes may require hospitalization. A typical manic episode is not caused by drug abuse, but having a co-occurring addiction can make it difficult to diagnose bipolar disorder.

Major Depressive Episode Symptoms

• Feeling depressed or hopeless most of the day
• Having a sense of worthlessness
• Weight loss or gain
• Restlessness
• Insomnia or feeling the need to oversleep
• Loss of interest or pleasure in once enjoyable activities
• Feeling fatigued nearly every day
• Excessive feelings of guilt
• Lack of concentration
• Thoughts of death or suicide

Major depressive episodes leave people unable to function in social or occupational settings. A person’s depressed mood has to last at least 2 weeks to meet the clinical definition of an episode. Like manic episodes, a true major depressive episode is not the result of drug abuse.

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More Frequently Asked Questions

How Is Bipolar Disorder Diagnosed?

Diagnosing bipolar disorder in a person with an addiction can be difficult, as the symptoms of the episodes experienced by people with bipolar disorder mirror many symptoms of drug abuse and addiction. Because of this, it generally takes a few extensive patient-physician interviews before a diagnosis is made.

Bipolar disorder is diagnosed by evaluating a patient and assessing their mood, thoughts, behavior patterns, and asking them about substance use and suicidal thoughts. Questions about family history, previous and current mental health history, and a detailed breakdown of manic and depressive episodes are important for a diagnosis. Family members and loved ones may also be asked questions in order to get a bigger picture.

It is also essential to rule out medical conditions such as thyroid disorders that can mirror bipolar disorder, and this is often done through a physical exam and lab tests.

Is It Drug Abuse, Bipolar Disorder, Or Both?

The symptoms of bipolar disorder often resemble the signs of drug use and addiction. Someone going through a manic episode can look and act like someone oncocaine. Both experience an elevated mood and energy. Those having a major depressive episode can also have the same symptoms as someone inwithdrawal.

If someone with an addiction has a co-occurring bipolar disorder, they need the help of someone trained in addiction and mental health to make the correct diagnosis, and even then, it can be challenging. Because symptoms of both conditions can overlap, it’s important to see an experienced specialist.

Because of this complicated overlap, it is important for people to be honest with their doctor and mental health professionals about their drug use. If someone hides or lies about their substance use, then they may receive a misdiagnosis, which can delay treatment and potentially worsen the condition.

How Do You Help A Loved One Who Is Bipolar And Abusing Substances?

If your loved one is bipolar and is abusing substances, it’s important to support them in seekingdual diagnosis treatment. The following are some ways to offer help:

• Taking them to doctors’ visits
• Ensuring they take their medication
• Attending family support groups
• Setting strict and healthy boundaries with them
• Educating yourself on both bipolar disorder and addiction
• Not enabling them
• Spending time with them
• Encouraging them to open up about their feelings
• Seeking self-care to take care of yourself so you can better support your loved one
• Showing patience, compassion, and empathy

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How Is Bipolar Disorder And Addiction Treated?

Bipolar and co-occurring addiction are treated simultaneously, meaning that there is a specific regimen for the substance use disorder that may includedetox andtherapy, and there are also medications to treat bipolar disorder.

It is important to treat both diagnoses at the same time because if either bipolar disorder or addiction is left untreated, it can continue to fuel and exacerbate the other disorder.

Medications

Addiction treatment medications are used to manage and ease withdrawal symptoms during the detox period, and reduce cravings and urges, thereby decreasing the risk ofrelapse.

Depending on the substance of abuse, there are FDA-approved medications to not only treat withdrawal symptoms but also to increase the success of long-term recovery. Some FDA-approved addiction medications include:

• Naltrexone
• Buprenorphine
• Methadone
• Lofexidine
• Acamprosate
• Disulfiram

Bipolar disorder is one of the mental health disorders that must be treated with medication.

Mood stabilizers are the first-line medications for bipolar disorder. The following are classes of mood stabilizers that are commonly used to treat bipolar disorder:

• Anticonvulsants: Anticonvulsants, used to treat seizure disorders, can also be used as mood stabilizers. These include carbamazepine, divalproex sodium, valproic acid, and lamotrigine.
• Atypical antipsychotics: Antipsychotics are generally used to treat psychotic disorders such as schizophrenia. However, they are also used to treat bipolar disorder, specifically manic episodes. Aripiprazole, clozapine, olanzapine, risperidone, ziprasidone, and quetiapine are common atypical antipsychotics used to treat bipolar disorder.
• Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) can be used to treat bipolar disorder.Antidepressant agents are generally not used with mood stabilizers and antipsychotics, as this dangerous combination can worsen an individual’s symptoms. Antidepressants are generally indicated only when the individual is experiencing the depressed phase with no symptoms of mania. Common antidepressants include citalopram, escitalopram,sertraline, fluoxetine, paroxetine, venlafaxine, andduloxetine.
• Lithium: Lithium was the first medication used to treat manic episodes. Although it requires careful monitoring, it is still commonly and effectively used as a first-line mood stabilizer.

It may take some trial and error before the individual responds to the best dose and medication regimen. As always, it is important to practice patience and communicate openly with your mental healthcare providers while you are undergoing treatment for bipolar disorder.

Inpatient Or Outpatient Rehab

A person struggling with an addiction and bipolar disorder can getaddiction treatment through aninpatient oroutpatient rehab where doctors use treatment medications and therapy to treat these conditions.

Factors that determine whether a person can go to inpatient or outpatient rehab include the severity of their addiction and bipolar disorder, the presence of any other medical conditions, whether there is a risk of suicide, the potential for withdrawal, insurance coverage, and whether the person has a stable home environment and a healthy support system.

Psychotherapy

Psychotherapies, specificallycognitive behavioral therapy (CBT), help people with addiction and co-occurring bipolar disorder. CBT addresses the thoughts and feelings that people with these conditions face.

By examining the thoughts and feelings that lead to manic and depressive behaviors, addicted people with bipolar disorder can better understand their actions. This helps them prepare for cravings and episodes, enabling them to manage their behavior.

Ongoing Care

Ongoing care is important for long-term treatment and recovery for both addiction and bipolar disorder. Ongoing care involves the following:

• Attending asupport group
• Continuing therapy
• Being compliant with medications
• Adopting healthy hobbies and passions
• Practicing self-care
• Learning to understand your diagnosis
• Adopting and enforcing a relapse and safety plan

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